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 ACID
DENIER’SHANDBOOK
THE PROBLEM
60%MASSIVE LYSIS
20,000+ subjects15% mortality RRR
STRATEGY 1DEFLECT THE ISSUE
TRANEXAMIC ACID
TRANEXAMIC ACIDTRAXENAMIC ACIDTRASENAMIC ACIDTAXIDERMIC ACIDTRIXYDIXY ACID
TRANSENEEMIC ACID
STRATEGY 2DISRESPECT THE STUDY
STRATEGY 2DISRESPECT THE STUDYDISRESPECT THE RESULTS
20,000+ subjects15% mortality RRR
20,000+ subjects15% mortality RRR
4.9% vs 5.7%0.8% ARR!!!
20,000+ subjects15% mortality RRR
4.9% vs 5.7%0.8% ARR!!!
NNT: 125
Deaths due to bleeding5.3% vs 7.7%
2.4% ARRNNT: 42
CRASH 2
CRASH 2 - Bleeders
CRASH 2
CRASH 2 - Bleeders
ROYAL LONDONMATTERS
CRASH 2
CRASH 2 - Bleeders
ROYAL LONDONMATTERS
RLH-SHOCKEDMATTERS- MT
STRATEGY 2DISRESPECT THE STUDY
STRATEGY 2DISRESPECT THE STUDY
DISRESPECT THE DESIGN
ISS
PRAGMATIC
STRATEGY 2DISRESPECT THE STUDY
STRATEGY 2DISRESPECT THE STUDY
DISRESPECT THE ETHICS
EQUIPOISE
STRATEGY 2DISRESPECT THE STUDY
STRATEGY 2DISRESPECT THE STUDYDISRESPECT THE SUBJECTS
STRATEGY 2DISRESPECT THE STUDY
STRATEGY 2DISRESPECT THE STUDY
DISRESPECT THE INVESTIGATORS
99% FOLLOW-UP
PANTS ON FIRE
STRATEGY 3SCAREMONGER
STRATEGY 4PUBLISH SOMETHING
(ANYTHING)
TXA INCREASED MORTALITY!
THETRANEXAMIC ACID
DENIER’SHANDBOOK
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