21 November 2017

A new meta-analysis published in The Lancet has emphasised the importance of timing and speed in administering tranexamic acid during severe bleeding.

"Traumatic extracranial haemorrhage, often the consequence of road traffic crashes or violence, is responsible for more than two million deaths each year," the researchers write, adding: "Traumatic and spontaneous intracranial bleeding are common causes of death and disability."

Antifibrinolytic drugs, such as tranexamic acid, reduce bleeding by inhibiting the breakdown of fibrin in blood clots. The team looked at the effect of treatment delay on the effectiveness of these drugs.

They analysed information on 40,138 patients from two randomised trials, covering 3,558 deaths, of which 40% were from bleeding.

The team found that 63% of the bleeding deaths occurred within 12hours of bleeding onset. Among the deaths were some cases of post-partum haemorrhage. These deaths peaked two to three hours after childbirth.

Analysis showed that tranexamic acid significantly increased overall survival from bleeding, by about 20%, irrespective of the site of bleeding. Delay to treatment significantly reduced its benefit.

When patients were treated immediately, survival improved by more than 70%, then the survival benefit fell by 10% for every 15 minutes delay until three hours, after which there was no benefit. Tranexamic acid was not linked to vascular occlusive events, they researchers say.

"Death from bleeding occurs soon after onset and even a short delay in treatment reduces the benefit of tranexamic acid administration. Patients must be treated immediately," they conclude.

Source: Gayet-Ageron, A. et al. Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40138 bleeding patients. The Lancet 8 November 2017 doi: 10.1016/S0140-6736(17)32455-8

Link: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32455-8/fulltext


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