CRASH-2

Overview

The CRASH-2 Trial was a large, randomised, placebo-controlled trial that evaluated the effect of the early administrations of tranexamic acid (TXA) on death and transfusion requirement in patients with traumatic bleeding or at significant risk of traumatic bleeding.

The trial also looked at the effect of TXA on the risk of non-fatal vascular events. The trial, which published its results in 2013, found that early administration of TXA safely reduced the risk of death in bleeding trauma patients and is highly cost-effective. Treatment beyond three hours of injury is unlikely to be effective.

On the basis of the CRASH-2 Trial, TXA was adopted as a WHO essential medicine for trauma. However, most victims of trauma are still not receiving this treatment within three hours of injury.

Trial in numbers

20,211

Participants recruited

40 Recruiting countries

274 Hospitals

Trial background

For people aged 5 to 45 years, trauma is second only to HIV and AIDS as a cause of death. Each year, worldwide, about three million people die as a result of trauma, many after reaching hospital.

Among trauma patients who survive to reach hospital, severe blood loss is a common cause of death. Blood is a scarce and expensive resource and major concerns remain about the risk of transfusion-transmitted infection.

A widely practicable treatment that reduces blood loss after trauma could prevent thousands of premature deaths each year

Antifibrinolytic agents are widely used in major surgery to prevent fibrinolysis and reduce surgical blood loss, however, its effect in adult trauma patients with significant haemorrhage, or who are considered to be at risk of significant haemorrhage is unknown.

The CRASH-2 Trial aimed to determine the effect of the early administration of TXA on death and transfusion requirement in bleeding trauma patients. In addition, the effort of TXA on the risk of vascular occlusive events was assessed.