Introduction
In the complex and urgent field of trauma care, evidence-based interventions are both critical to improving patient outcomes and surprisingly rare. One such intervention that has gained prominence is tranexamic acid (TXA). This blog explores the discovery of TXA, the pivotal role played by Professor Ian Roberts and the CRASH studies in promoting its use, and the ongoing efforts of the IMPACT team to address its underutilisation in prehospital medicine.
The Discovery of Tranexamic Acid
Tranexamic acid is a synthetic derivative of the amino acid lysine, discovered in the 1960s by Japanese researchers Shosuke and Utako Okamoto. Initially developed to treat excessive bleeding during surgery and heavy menstrual bleeding, TXA works by inhibiting the breakdown of fibrin, a protein essential for blood clotting. This mechanism helps reduce bleeding by stabilizing clots, making TXA a valuable tool in various medical settings.
This video from the London School of Hygiene and Tropical Medicine is an excellent (and fun) guide to how TXA works
The CRASH Studies and the Work of Ian Roberts and Team
Professor Ian Roberts of the London School of Hygiene and Tropical Medicine and his team of investigators has been instrumental in advancing the use of TXA in trauma care through the CRASH studies. The CRASH-2 trial, conducted in over 40 countries and involving more than 20,000 patients, was a landmark randomised controlled trial (RCT) that investigated the effects of TXA in trauma patients with significant bleeding. Published in 2010, the study demonstrated that TXA significantly reduced the risk of death due to bleeding without increasing the risk of adverse events. The findings of the CRASH-2 trial led to a substantial increase in the use of TXA in trauma care worldwide, cementing its place as a critical intervention for bleeding control.
Proven Efficacy in Prehospital Medicine
Tranexamic acid is one of the few evidence-based interventions for trauma care that has proven efficacy through RCTs. The CRASH-2 trial and subsequent studies have shown that early administration of TXA, ideally within three hours of injury, can save lives by reducing mortality from bleeding. Its inclusion in prehospital care protocols represents a significant advancement in trauma management, providing first responders with a powerful tool to stabilise patients before they reach a hospital.
Underutilization of Tranexamic Acid
Despite its proven benefits, TXA remains underutilised in many parts of the world. Various factors contribute to this underutilisation, including lack of awareness, logistical challenges, and disparities in healthcare resources. Ensuring that TXA is available and administered promptly in prehospital settings is essential for maximizing its life-saving potential.
Understanding Inequities in Trauma Care
A recent journal article published in the British Journal of Anaesthesia (BJA) from members of the IMPACT Team highlights these issues in detail. The study found significant variations in the use of TXA between women and men, pointing to a need for targeted efforts to achieve equality and equity in health care. We advocated for standardised protocols and increased education to ensure that all trauma patients have access to this crucial intervention.
We were proud ot have our papers featured in the “top 10” review from St Emlyns here.
And covered by the Guardian here
You can read more about our research here
Future Directions for IMPACT
IMPACT is committed to addressing these inequities in trauma care. Our team will be conducting detailed research to understand the barriers to TXA use and develop strategies to promote its wider adoption in prehospital settings. We will work closely with healthcare providers, policymakers, and community organisations to ensure that TXA is widely available and utilised effectively to save lives. We look forward to sharing our findings and plans in the coming months as we strive to improve trauma care and patient outcomes.
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