Trial reportTrials2017
Tranexamic acid in bleeding trauma patients: an exploration of benefits and harms.
Trial report in Trials, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00375258 (A Large Randomised Placebo Controlled Trial Among Trauma Patients With, or at Risk of, Significant Haemorrhage, of the Effects of Antifibrinolytic Treatment on Death and Transfusion Requirement), which is not on this map. Cited by 21 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Large Randomised Placebo Controlled Trial Among Trauma Patients With, or at Risk of, Significant Haemorrhage, of the Effects of Antifibrinolytic Treatment on Death and Transfusion Requirement
Who cites it
21 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Prehospital coagulation management and fluid replacement therapy in patients with multiple and/or severe injuries - A systematic review and clinical practice guideline update.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Pooled it
- Inhospital coagulation management and fluid replacement therapy in patients with multiple and/or severe injuries - a systematic review and clinical practice guideline update.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Pooled it
- Systemic hemostatic agents initiated in trauma patients in the pre-hospital setting: a systematic review.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023Pooled it
- Factors that influence the administration of tranexamic acid (TXA) to trauma patients in prehospital settings: a systematic review.BMJ open · 2023Pooled it
- Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis.Critical care (London, England) · 2021Pooled it
- Can tranexamic acid reduce the blood transfusion rate in patients undergoing percutaneous nephrolithotomy? A systematic review and meta-analysis.The Journal of international medical research · 2020Pooled it
- Effect of Prophylactic Tranexamic Acid on Peripartum Changes in Haemoglobin Concentration After Vaginal Delivery.Sultan Qaboos University medical journal · 2025Trial
- Benefits of the tranexamic acid in head trauma with no extracranial bleeding: a prospective follow-up of 180 patients.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2019Trial
- Article
- Review
- Multivalent Tranexamic Acid (TXA) and Benzamidine Derivatives for Serine Protease Inhibition.ACS pharmacology & translational science · 2025Article
- Evaluation of the prehospital administration of tranexamic acid for injured patients: a state-wide observational study with sex and age-disaggregated analysis.Emergency medicine journal : EMJ · 2024Observational
- [Prehospital treatment of polytrauma : Ongoing challenge in prehospital emergency services].Unfallchirurgie (Heidelberg, Germany) · 2023Article
- Ukraine Trauma Project: the feasibility of introducing advanced trauma-care skills to frontline emergency medical services responders.BMJ open · 2023Article
- [The chapters "Stop the bleed-prehospital" and "Coagulation management and volume therapy (emergency departement)" in the new S3 guideline "Polytrauma/severe injury treatment"].Notfall & rettungsmedizin · 2023Review
- Tranexamic acid in Neurosurgery: a controversy indication-review.Neurosurgical review · 2021Review
- Article
- To Clot or Not: HELLP Syndrome and Disseminated Intravascular Coagulation in an Eclamptic Patient with Intrauterine Fetal Demise.Case reports in anesthesiology · 2020Article
- Fibrinolysis Shutdown in Trauma: Historical Review and Clinical Implications.Anesthesia and analgesia · 2019Review
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
backgroundThe CRASH-2 trial showed that tranexamic acid (TXA) administration reduces mortality in bleeding trauma patients. However, the effect appeared to depend on how soon after injury TXA treatment was started. Treatment within 3 h reduced bleeding deaths whereas treatment after 3 h increased the risk. We examine how patient characteristics vary by time to treatment and explore whether any such variations explain the time-dependent treatment effect.
methodsExploratory analysis were carried out, including per-protocol analyses, of data from the CRASH-2 trial, a randomised placebo-controlled trial of the effect of TXA on mortality in 20,211 trauma patients with, or at risk of, significant bleeding. We examine how patient characteristics (age, type of injury, presence or absence of head injury, Glasgow coma scale (GCS), systolic blood pressure and capillary refill time) vary with time to treatment and use univariable (restriction) and multivariable methods to examine whether any such variations explain the time-dependent effect of TXA. If not explained by differences in patient characteristics, we planned to conduct separate prespecified subgroup analyses for the early benefit and late harm.
resultsThere was no substantial variation in age or capillary refill by time to treatment. However, the proportion of patients with blunt trauma, the proportion with head injury and mean systolic blood pressure increased as time to treatment increased. Mean GCS decreased as time to treatment increased. Analyses restricted to patients with blunt trauma, those without head injury and those with a systolic blood pressure <100 mmHg showed that these characteristics did not explain the time-dependent treatment effect. In a multivariable analysis the interaction with time to treatment remained highly significant (p < 0.0001). Separate subgroup analyses that examine how the benefits of early TXA treatment and the harms of late TXA treatment vary by systolic blood pressure (≤75, 76-89, >89 mmHg); GCS (severe 3-8, moderate 9-12, mild 13-15); and type of injury (penetrating versus blunt) showed no significant heterogeneity.
conclusionsThe time-dependent effect of TXA in bleeding trauma patients is not explained by the type of injury, the presence or absence of head injury or systolic blood pressure. When given within 3 h of injury, TXA reduces death due to bleeding regardless of type of injury, GCS or blood pressure.
trial registrationClinicalTrials.gov, NCT00375258 . Registered on 11 September 2006.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.