Traumatic Extra-Cranial Bleeding

Each year, worldwide, nearly six million people die from trauma, many after reaching hospital. Among trauma patients who survive to reach hospital, extra-cranial bleeding is a common cause of death, accounting for around 40% of in-hospital deaths.

The CRASH-2 trial evaluated the effect of tranexamic acid on death and vascular occlusive events in patients with traumatic extra-cranial bleeding. The results were published in 2010.

A total of 20,211 adult trauma patients with significant bleeding, who were within 8 hours of their injury, were randomly allocated to receive tranexamic acid (1 g over 10 min followed by an infusion of 1 g over 8 h) or matching placebo.

Tranexamic acid significantly reduced death due to bleeding (RR = 0.85, 95% CI 0.76–0.96) and all-cause mortality (RR = 0.91, 95% CI 0.85–0.97), with no increase in vascular occlusive events.

The reduction in death due to bleeding was greatest when tranexamic acid was given within 3 hours of injury, (RR = 0.72, 95% CI 0.63–0.83).  When tranexamic acid was given after 3 hours, there was no mortality reduction.

On the basis of these results, tranexamic acid was added to the WHO Essential Medicines List and to trauma protocols.

traumatic intra-cranial bleeding trial


Treatment within three hours of injury reduces deaths due to bleeding by about one third.


Relative risk= 0.72 (0.63–0.83); p<0.001

Death Death Alive Alive


All Videos

04. 05. 2017

TXA in Casualty

A scene from the TV show Casualty where a patient with a Femoral arterial stab wound is treated with TXA.

01. 05. 2017

Catalyst: Episode on bleeding in trauma

Episode from Australian TV show, Catalyst focussing on traumatic injuries, what these injuries can do to the blood and the important role of TXA in treatment of these injuries.

05. 03. 2017

Use of TXA for Injured soldiers

Surgeon General – Surgeon Vice Admiral Philip Raffaelli interviewed about implementation of the CRASH-2 trial results in the British Military

05. 02. 2017

CRASH-2 trial TRANMAN cartoon

TRANMAN - a clot stabiliser can save the lives of trauma victims.

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