Can TXA save lives in head injuries, CRASH-3; Roadside to Resus
The Resus Room
Simon Laing
4.8 • 678 Ratings
🗓️ 15 October 2019
⏱️ 40 minutes
🧾️ Download transcript
Summary
So an incredibly important paper, CRASH-3 has just been published in the Lancet, which looks at the treatment of head injuries with Tranexamic Acid (TXA).
TXA has been shown to save lives in trauma patients at the risk of major haemorrhage, with the notable exclusion of those with head injuries, CRASH-2. TXA has been shown to save lives in those with post parts haemorrhage, WOMAN trial. Time to treatment with TXA has been shown to be hugely influential in it's ability to decrease blood loss and save lives. So has TXA now been shown to save lives in head injuries?
In this episode we run through the paper and are lucky enough to have an interview with the lead author, Professor Ian Roberts.
Have a listen, read the paper and as always we’d love to hear any thoughts or comments you have on the website and via twitter, and take a look at the references below to draw your own conclusions.
Enjoy!
Simon, Rob & James
References
The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients.Roberts I. Health Technol Assess. 2013
CRASH-2;The Bottom Line
Effectof earlytranexamic acidadministrationon mortality, hysterectomy, and othermorbiditiesin womenwith post-partum haemorrhage(WOMAN): an international, randomised, double-blind, placebo-controlledtrial. WOMANTrialCollaborators.Lancet 2017
WOMAN Trial;The Bottom Line
Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients.Gayet-Ageron A. Lancet. 2017
Tranexamic Acid - The Mechanism of Action;Video
Tranexamic Acid, Time to Treatment;The Resus Room
Does earlier TXA save lives?St Emlyns
TXA podcast; PHEMCAST
About CRASH-3; LSHTM
Transcript
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| 0:00.0 | Welcome to the recess room podcast. |
| 0:03.5 | Five, four, three, two, one, fire. |
| 0:11.9 | So hi, and welcome back to the recess room podcast. I'm Simon Lang, and I'm Rob Fenwick. And I'm James |
| 0:18.0 | Yates. And we have got a big episode for you today. Oh yes. I'm excited |
| 0:23.8 | about this one. I mean, this has got to be one of our biggest, most influential, most potential to change practice podcasts ever, I reckon. |
| 0:33.0 | I agree with you totally, James. And you know how big it is when we wheeled James Yates out to review a paper. |
| 0:38.4 | It is that. |
| 0:41.9 | You mean I'm allowed to come out and have a little go? |
| 0:44.8 | You're always welcome. |
| 0:46.7 | Thanks. |
| 0:47.9 | So you've probably already gathered it from the title but we're going to be talking about Crash 3, which has literally just been released |
| 0:55.6 | at the point of release of this podcast. So Crash 3 is looking at Tranexamic acid in the context |
| 1:01.9 | of head injury and whether or not it can be used as a life-saving treatment. We're going to be |
| 1:07.6 | running through the paper, which has just been released in the Lancet in the last few minutes. |
| 1:12.8 | A huge thanks to the lead authors for making this all possible. |
| 1:15.9 | And most importantly, we've got an interview from the lead author himself, Ian Roberts, which we'll be coming to really shortly. |
| 1:22.8 | And before we go into it, a big thanks to our partners, S.J. Trem, the Scandinavian Journal of Trauma, Resuscitation |
| 1:29.3 | emergency medicine who make this whole podcast possible. So we've got a lot to talk about. I think |
| 1:35.3 | we need to get straight into it. All right. Well, I guess the best place to start with this |
| 1:44.0 | podcast then is a very quick discussion on TXA, |
| 1:47.6 | maybe a little bit about how it works and some of the history behind the evidence that we know so far running up to this trial. |
| 1:55.3 | So what is TXA then? Well, TXA is an anti-fibranolytic agent. What does that mean? Well, it kind of stops or slows down |
... |
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