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Research and Projects

TXA in Trauma

Who is involved?

Theme: Evidence for Policy and Practice
Status: Complete

Read a BITE sized summary of this project.

Background

PenCLAHRC worked with NHS teams and the South Western Ambulance Service NHS Foundation Trust (SWAST) to implement a blood clotting drug which have the potential to save the lives of trauma patients across the Peninsula.

Tranexamic Acid (TXA) is a cheap blood-clotting drug which has been found to reduce the risk of death of patients with severe bleeding by 10%.

The 20,000 patient CRASH-2 trial provides strong evidence of benefit in patients with traumatic haemorrhage, with no evidence of an increased risk of vascular inclusion events, need for surgery or number of blood transfusions.

A more recent analysis of the 2010 CRASH-2 study shows that TXA should be given as early as possible to bleeding trauma patients. If given within the first hour, the drug has been found to reduce the risk of death due to bleeding by around one third. If treatment is not given within three hours of injury, it is less effective and could even be harmful.

It has also been shown that early administration of TXA to bleeding trauma patients is likely to be highly cost effective in low, middle and high income settings.

The drug cost around £3.10 per person and getting the drug to all appropriate trauma patients could save around 400 lives per year in the UK.

Impacts

PenCLAHRC worked in partnership with the South Western Ambulance Service NHS Foundation Trust (SWAST) and Acute trusts in the region to introduce TXA for use by paramedics, nurses and doctors. Following liaison, TXA was introduced to ambulance crew and emergency departments at all acute hospital trusts in the South West from 1st December 2011. All emergency ambulances across Devon, Somerset and Dorset, Cornwall and Isles of Scilly are carrying the drug. All the hospital trusts in the region have also introduced TXA in their emergency departments and have developed local guidelines and protocols for its use.

All ambulance services in England are now using TXA and guidelines for TXA use have been included in the National Guidelines for the Joint Royal Colleges Ambulance Liaison Committee for use across the UK.

Please see the Tranexamic Acid project page on the SWAST website for more information, including the Patient Group Direction (Guidance for Administration).

See below two videos related to tranexamic acid and the CRASH2 trial:

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Downloads

  • TXA guidelines - Ambulance Service Clinical Practice Guidelines - PDF
  • SWAST TXA Summary for Clinicians - PDF
  • Briefing: Use of TXA in Trauma Care - PDF
  • CRASH-2 trial (presentation) - PDF