Tranexamic Acid in Trauma by Karim Brohi

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TRANEXAMIC ACID IN TRAUMA Queen Mary University of London www.c4ts.qmul.ac.uk Royal London Major Trauma Centre Barts Health NHS Trust KARIM BROHI, FRCS FRCA Professor of Trauma Sciences, QMUL Clinical Director, London Major Trauma System

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Transcript of Tranexamic Acid in Trauma by Karim Brohi

Karim Brohi

TRANEXAMIC ACID IN TRAUMA

Queen Mary University of Londonwww.c4ts.qmul.ac.uk

Royal London Major Trauma CentreBarts Health NHS Trust

KARIM BROHI, FRCS FRCAProfessor of Trauma Sciences, QMULClinical Director, London Major Trauma System

THETRANEXAMIC ACIDDENIERSHANDBOOK

THE PROBLEM

60%MASSIVE LYSIS

20,000+ subjects15% mortality RRR

STRATEGY 1DEFLECT THE ISSUE

TRANEXAMIC ACID

TRANEXAMIC ACIDTRAXENAMIC ACIDTRASENAMIC ACIDTAXIDERMIC ACIDTRIXYDIXY ACIDTRANSENEEMIC ACID

STRATEGY 2DISRESPECT THE STUDY

STRATEGY 2DISRESPECT THE STUDYDISRESPECT THE RESULTS

20,000+ subjects15% mortality RRR

20,000+ subjects15% mortality RRR4.9% vs 5.7%0.8% ARR!!!

20,000+ subjects15% mortality RRR4.9% vs 5.7%0.8% ARR!!!NNT: 125

Deaths due to bleeding5.3% vs 7.7%2.4% ARRNNT: 42

CRASH 2CRASH 2 - Bleeders

CRASH 2CRASH 2 - BleedersROYAL LONDONMATTERS

CRASH 2CRASH 2 - BleedersROYAL LONDONMATTERSRLH-SHOCKEDMATTERS- MT

STRATEGY 2DISRESPECT THE STUDY

STRATEGY 2DISRESPECT THE STUDYDISRESPECT THE DESIGN

ISS

PRAGMATIC

STRATEGY 2DISRESPECT THE STUDY

STRATEGY 2DISRESPECT THE STUDYDISRESPECT THE ETHICS

EQUIPOISE

STRATEGY 2DISRESPECT THE STUDY

STRATEGY 2DISRESPECT THE STUDYDISRESPECT THE SUBJECTS

STRATEGY 2DISRESPECT THE STUDY

STRATEGY 2DISRESPECT THE STUDYDISRESPECT THE INVESTIGATORS

99% FOLLOW-UP

PANTS ON FIRE

STRATEGY 3SCAREMONGER

STRATEGY 4PUBLISH SOMETHING(ANYTHING)

TXA INCREASED MORTALITY!

THETRANEXAMIC ACIDDENIERSHANDBOOK