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BMC Emergency Medicine
Published in: BMC Emergency Medicine 1/2012

Open Access 01-12-2012 | Research article

Avoidable mortality from giving tranexamic acid to bleeding trauma patients: an estimation based on WHO mortality data, a systematic literature review and data from the CRASH-2 trial

Authors: Katharine Ker, Junko Kiriya, Pablo Perel, Phil Edwards, Haleema Shakur, Ian Roberts

Published in: BMC Emergency Medicine | Issue 1/2012

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Abstract

Background

The CRASH-2 trial showed that early administration of tranexamic acid (TXA) safely reduces mortality in bleeding in trauma patients. Based on data from the CRASH-2 trial, global mortality data and a systematic literature review, we estimated the number of premature deaths that might be averted every year worldwide through the use of TXA.

Methods

We used CRASH-2 trial data to examine the effect of TXA on death due to bleeding by geographical region. We used WHO mortality data (2008) and data from a systematic review of the literature to estimate the annual number of in-hospital trauma deaths due to bleeding. We then used the relative risk estimates from the CRASH-2 trial to estimate the number of premature deaths that could be averted if all hospitalised bleeding trauma patients received TXA within one hour of injury, and within three hours of injury. Sensitivity analyses were used to explore the effect of uncertainty in the parameter estimates and the assumptions made in the model.

Results

There is no evidence that the effect of TXA on death due to bleeding varies by geographical region (heterogeneity p = 0.70). Based on WHO data and our systematic literature review, we estimate that each year worldwide there are approximately 400,000 in-hospital trauma deaths due to bleeding. If patients received TXA within one hour of injury then approximately 128,000 (uncertainty range [UR] ≈ 72,000 to 172,000) deaths might be averted. If patients received TXA within three hours of injury then approximately 112,000 (UR ≈ 68,000 to 148,000) deaths might be averted. Country specific estimates show that the largest numbers of deaths averted would be in India and China.

Conclusions

The use of TXA in the treatment of traumatic bleeding has the potential to prevent many premature deaths every year. A large proportion of the potential health gains are in low and middle income countries.
Appendix
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Metadata
Title
Avoidable mortality from giving tranexamic acid to bleeding trauma patients: an estimation based on WHO mortality data, a systematic literature review and data from the CRASH-2 trial
Authors
Katharine Ker
Junko Kiriya
Pablo Perel
Phil Edwards
Haleema Shakur
Ian Roberts
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Emergency Medicine / Issue 1/2012
Electronic ISSN: 1471-227X
DOI
https://doi.org/10.1186/1471-227X-12-3

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