Professor Tim Coats has written an excellent site outlining how to implemement the use of tranexamic acid in emergency trauma care.

The CRASH2 trial studied the use of tranexamic acid in the management of injured patients. The results of the trial were published in the Lancet in 2010, with a follow up paper in the Lancet in May 2011. The trial showed that treatment with tranexamic acid reduced patient mortality from 16% to 14.5%, thus preventing 9% of all trauma deaths. The number needed to treat was 67 – in other words one life was saved for every 67 patients treated. This means that the treatment cost of saving a life is about £200. The potential number of lives that we could save in the UK is about 500 per year.

Some Emergency Departments use tranexamic acid only as part of their Massive Transfusion Protocol – I was interested to learn that this restriction is invalid.

The Tranexamic Acid Implementation Guide covers the following areas:

• What is the evidence for the use of TXA?
• What is the indication for TXA use?
• How is tranexamic acid given?
• How soon should it be given?
• How is the implementation of the CRASH2 results going?
• Are there any mistakes being made in implementation?
• How can I implement Tranexamic Acid in my Emergency Department?
• How do I ensure that Tranexamic Acid is available?
• How do I train my staff?
• How do I audit tranexamic acid usage?
• How important is the implementation of CRASH2?
• What are people saying about Tranexamic Acid use in trauma patients?