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CRASH2. Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage. “...in Italy for 30 years under the Borgias they had warfare, terror, murder, and bloodshed, but they produced Michelangelo, Leonardo da Vinci, and the Renaissance.

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CRASH2

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CRASH2

Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage


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“...in Italy for 30 years under the Borgias they had warfare, terror, murder, and bloodshed, but they produced Michelangelo, Leonardo da Vinci, and the Renaissance...


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“In Switzerland they had brotherly love - they had 500 years of democracy and peace, and what did that produce? The cuckoo clock.”


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Scale of problem

  • Worldwide:

    • 1.6 million deaths annually

    • RTC 9th most common cause of death

    • Disproportionate impact on younger age groups

  • UK:

    • 6 million ED attendances

    • 720 000 admissions

    • 17 000 deaths


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CRASH2

  • Prospective, multicentre RCT

  • 20 211 patients

  • 274 Hospitals

  • 40 Countries

  • Commenced May 2005


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Design

  • Trauma patients

    • BP<90mmHg systolic

    • HR>110

    • Clinical suspicion of significant haemorrhage

    • Within 8 hours of injury

  • Randomised to:

    • Tranexamic acid, 1g/10min loading then 1g/8hr

    • Placebo


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Recruitment


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Analysis

  • Primary outcome: all cause mortality within four weeks

  • Secondary outcomes:

    • Vascular occlusive events

    • Surgical intervention

    • Blood transfusion

    • Units blood transfused

    • Dependancy on discharge/day 28


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Results


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Dependency


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Discussion

  • Significant reduction in mortality

  • Significant increase in fully independent survivors

  • No change in need for surgery

  • No change in need for transfusion or amount transfused

    • ?surviving longer

    • ?early estimate of loss inaccurate


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Summary

  • 1.5% absolute reduction (9% relative risk reduction) in all-cause mortality at 28 days

  • Reduced morbidity

  • No effect on need for operation or transfusion

  • ~£5 per patient

  • Role in ED, Theatre 9, ITU?


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Thank you


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