Tranexamic Acid (TXA) is a drug that inhibits fibrinolysis, the breaking down of blood clots, which can worsen bleeding in situations like major trauma. The National Institute for Health Research (NIHR) funded a large international study, the CRASH-2 trial which involved 20,000 trauma patients from 274 hospitals in 40 countries and showed that, if used within three hours after trauma, TXA can reduce the risk of death from bleeding by as much as 30 per cent. These findings suggested that getting the drug to trauma patients could save around 400 lives per year in the UK. The drug was quickly moved into routine practice by trauma teams in the military but the challenge was how best to get TXA used in the NHS ambulance service and in hospital trusts.
PenCLAHRC worked with NHS teams and the South West Ambulance Service NHS Foundation Trust (SWASFT) to introduce TXA for use by paramedics, nurses and doctors in the region. Adrian South, Deputy Director of Clinical Care, South West Ambulance Service NHS Foundation Trust said, “by working in collaboration with PenCLAHRC, we have been able to introduce the medicine far earlier than would have otherwise have been possible.”
Professor Stuart Logan, Director of PenCLAHRC said “The South West is lucky to have an ambulance trust with a really innovative approach and a commitment to evidence-based practice. There is often a delay of years between evidence being published and its use in public, but this is a great example of what the NHS at its best can do.”
All ambulance services in England are now using TXA and guidelines for TXA use have been included in the National Guidelines for the Joint Royal Colleges Ambulance Liaison Committee for use across the UK.
See below two videos related to tranexamic acid and the CRASH2 trial:
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- Authors: Paudyal P., Smith J., Robinson, M.,South A., Higginson I., Reuben A., Shaffee J., Black S., Logan S. Tranexamic acid in major trauma: implementation and evaluation across South West England