Tranexamic acid for trauma: optimal timing of administration based on the CRASH-2 and CRASH-3 trials
Authors' conclusion
Tranexamic acid administration was found to be beneficial when given within 2 h of injury. In patients with severe traumatic brain injury, the treatment benefits may persist beyond the 2-hour window.
Study context
- Population
- Trauma patients in the CRASH-2 and CRASH-3 randomised trials
- Participants
- 28,448 patients
- Comparison
- TXA vs no TXA, heterogeneity of effect by covariates
- Primary endpoint
- Heterogeneity in the effects of TXA on 24-hour mortality rate
- Follow-up
- 24 hours
Methodological detailsmachine learning-based causal forest models, policytree algorithm
- Machine learning-based causal forest models
- Policytree algorithm
Primary result
As reported in the abstract
24-hour mortality rate
- Heterogeneity in the effects of TXA on 24-hour mortality rate
- Relative risk reduction greatest when treated within 2 h of injury, decreasing rapidly thereafter
- Pattern similar regardless of age or SBP; with decreasing GCS, time-to-treatment effects weaker, with benefits beyond 3 h
- Largest absolute risk reductions with low BP and low GCS when treated soon after injury
- Optimal criterion: within 2 h of injury or GCS < 9
Original publication
Tranexamic acid for trauma: optimal timing of administration based on the CRASH-2 and CRASH-3 trials. Br J Surg. Published 25 April 2025. doi:10.
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