Accident victims could be saved by ‘cheap’ medicine

15th June 2010 - The lives of up to100,000 trauma victims worldwide could be saved each year if they were given access to a cheap, widely available and easily administered medication, according to a major investigation.

Experts involved in the CRASH-2 study say that tranexamic acid (TXA), which reduces the rate of blood-clot breakdown, is so effective it should be included on the World Health Organisation (WHO) list of essential medicines.

Nearly six million deaths

Injuries are a leading cause of death worldwide. “5.8 million die every year from injuries,” Dr. Etienne Krug, Director of Violence and Injury Prevention and Disability at the World Health Organisation, told a London press conference held to publish the research. “This is much more than HIV, TB and malaria deaths combined," he said.

Of those deaths, more than two million die as a result of road traffic injuries, making it the ninth leading cause of death globally. About 1.6 million die from violence, warfare and suicide. Furthermore, haemorrhage is responsible for about a third of in-hospital trauma deaths, as well as contributing to deaths from multi-organ failure.

“Each year about 600,000 injured patients bleed to death worldwide,” said chief investigator Professor Ian Roberts of the London School of Hygiene and Tropical Medicine in a statement.

The study

Researchers carried out a randomised trial involving over 20,000 adult patients in 274 hospitals across 40 countries. Participants received either one gram of TXA by injection, followed by another one gram in a drip over the following eight hours, or a matching placebo.  

The researchers studied the numbers of deaths in hospital within four weeks of injury. They discovered that TXA reduced the risk of death by any cause by 10% compared with those who received the placebo. 14•5% of patients in the TXA group died compared with 16% in the placebo group.

Although the research team was concerned that TXA might increase the risk of complications, such as heart attacks, strokes and clots in the lungs, they said that the results of CRASH-2 showed that TXA reduces death from bleeding without any increase in these complications. "The good news was we didn't see any evidence of increase [in unwanted clotting] at all,” Roberts told the press conference. “In fact we saw some decrease in the risk," he added.

Saving up to 100,000 lives

The researchers estimate that TXA could prevent between 70,000 and 100,000 deaths worldwide if it was readily available for trauma victims. In India it could save about 13,000 lives each year, with about 12,000 lives saved in China. The medication could also have a dramatic impact on deaths in developed countries, with around 2,000 lives saved each year in the US and more across Europe.