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Immediate treatment improved survival by more than 70% (odds ratio, 1.72; 95%; confidence interval, 1.42-2.10; P less than .0001), but the survival benefit decreased by 10% for every 15 minutes of treatment delay until hour 3, after which there was no benefit with tranexamic acid.
“Even a short delay in treatment reduces the benefit of tranexamic acid administration. Patients must be treated immediately,” said investigators led by Angele Gayet-Ageron, MD, PhD, of University Hospitals of Geneva.
“Trauma patients should be treated at the scene of injury and postpartum hemorrhage should be treated as soon as the diagnosis is made. Clinical audit should record the time from bleeding onset to tranexamic acid treatment, with feedback and best practice benchmarking,” they said in the Lancet.
The team found no increase in vascular occlusive events with tranexamic acid and no evidence of other adverse effects, so “it can be given safely as soon as bleeding is suspected,” they said.
Antifibrinolytics like tranexamic acid are known to reduce death from bleeding, but the effects of treatment delay have been less clear. To get an idea, the investigators ran a meta-analysis of subjects from two, large randomized tranexamic acid trials, one for trauma hemorrhage and the other for postpartum hemorrhage.
There were 1,408 deaths from bleeding among the 40,000-plus subjects. Most of the bleeding deaths (63%) occurred within 12 hours of onset; deaths from postpartum hemorrhage peaked at 2-3 hours after childbirth.
The authors had no competing interests. The trials were funded by the Britain’s National Institute for Health Research and Pfizer, among others.
SOURCE: Gayet-Ageron A et al. Lancet. 2017 Nov 7. doi: 10.1016/S0140-6736(17)32455-8
Early administration of tranexamic acid appears to offer the best hope for a good outcome in a bleeding patient with hyperfibrinolysis. The effect of tranexamic acid on inflammation and other pathways in patients without active bleeding is less clear. It is also unclear whether thromboelastography will move out of the research laboratory and become a routine means of assessment for bleeding patients.
At present, the careful study of Dr. Gayet-Ageron and her coworkers suggests applicability of early administration of this agent in patients with substantial bleeding from multiple causes. As data from additional trials with tranexamic acid become available, the spectrum of applications for this agent should become apparent.
David Dries, MD, is a professor of surgery at the University of Minnesota, Minneapolis. He made his comments in an editorial (Lancet. 2017 Nov 7. doi: 10.1016/S0140-6736(17)32806-4) and had no competing interests.
Early administration of tranexamic acid appears to offer the best hope for a good outcome in a bleeding patient with hyperfibrinolysis. The effect of tranexamic acid on inflammation and other pathways in patients without active bleeding is less clear. It is also unclear whether thromboelastography will move out of the research laboratory and become a routine means of assessment for bleeding patients.
At present, the careful study of Dr. Gayet-Ageron and her coworkers suggests applicability of early administration of this agent in patients with substantial bleeding from multiple causes. As data from additional trials with tranexamic acid become available, the spectrum of applications for this agent should become apparent.
David Dries, MD, is a professor of surgery at the University of Minnesota, Minneapolis. He made his comments in an editorial (Lancet. 2017 Nov 7. doi: 10.1016/S0140-6736(17)32806-4) and had no competing interests.
Early administration of tranexamic acid appears to offer the best hope for a good outcome in a bleeding patient with hyperfibrinolysis. The effect of tranexamic acid on inflammation and other pathways in patients without active bleeding is less clear. It is also unclear whether thromboelastography will move out of the research laboratory and become a routine means of assessment for bleeding patients.
At present, the careful study of Dr. Gayet-Ageron and her coworkers suggests applicability of early administration of this agent in patients with substantial bleeding from multiple causes. As data from additional trials with tranexamic acid become available, the spectrum of applications for this agent should become apparent.
David Dries, MD, is a professor of surgery at the University of Minnesota, Minneapolis. He made his comments in an editorial (Lancet. 2017 Nov 7. doi: 10.1016/S0140-6736(17)32806-4) and had no competing interests.
Immediate treatment improved survival by more than 70% (odds ratio, 1.72; 95%; confidence interval, 1.42-2.10; P less than .0001), but the survival benefit decreased by 10% for every 15 minutes of treatment delay until hour 3, after which there was no benefit with tranexamic acid.
“Even a short delay in treatment reduces the benefit of tranexamic acid administration. Patients must be treated immediately,” said investigators led by Angele Gayet-Ageron, MD, PhD, of University Hospitals of Geneva.
“Trauma patients should be treated at the scene of injury and postpartum hemorrhage should be treated as soon as the diagnosis is made. Clinical audit should record the time from bleeding onset to tranexamic acid treatment, with feedback and best practice benchmarking,” they said in the Lancet.
The team found no increase in vascular occlusive events with tranexamic acid and no evidence of other adverse effects, so “it can be given safely as soon as bleeding is suspected,” they said.
Antifibrinolytics like tranexamic acid are known to reduce death from bleeding, but the effects of treatment delay have been less clear. To get an idea, the investigators ran a meta-analysis of subjects from two, large randomized tranexamic acid trials, one for trauma hemorrhage and the other for postpartum hemorrhage.
There were 1,408 deaths from bleeding among the 40,000-plus subjects. Most of the bleeding deaths (63%) occurred within 12 hours of onset; deaths from postpartum hemorrhage peaked at 2-3 hours after childbirth.
The authors had no competing interests. The trials were funded by the Britain’s National Institute for Health Research and Pfizer, among others.
SOURCE: Gayet-Ageron A et al. Lancet. 2017 Nov 7. doi: 10.1016/S0140-6736(17)32455-8
Immediate treatment improved survival by more than 70% (odds ratio, 1.72; 95%; confidence interval, 1.42-2.10; P less than .0001), but the survival benefit decreased by 10% for every 15 minutes of treatment delay until hour 3, after which there was no benefit with tranexamic acid.
“Even a short delay in treatment reduces the benefit of tranexamic acid administration. Patients must be treated immediately,” said investigators led by Angele Gayet-Ageron, MD, PhD, of University Hospitals of Geneva.
“Trauma patients should be treated at the scene of injury and postpartum hemorrhage should be treated as soon as the diagnosis is made. Clinical audit should record the time from bleeding onset to tranexamic acid treatment, with feedback and best practice benchmarking,” they said in the Lancet.
The team found no increase in vascular occlusive events with tranexamic acid and no evidence of other adverse effects, so “it can be given safely as soon as bleeding is suspected,” they said.
Antifibrinolytics like tranexamic acid are known to reduce death from bleeding, but the effects of treatment delay have been less clear. To get an idea, the investigators ran a meta-analysis of subjects from two, large randomized tranexamic acid trials, one for trauma hemorrhage and the other for postpartum hemorrhage.
There were 1,408 deaths from bleeding among the 40,000-plus subjects. Most of the bleeding deaths (63%) occurred within 12 hours of onset; deaths from postpartum hemorrhage peaked at 2-3 hours after childbirth.
The authors had no competing interests. The trials were funded by the Britain’s National Institute for Health Research and Pfizer, among others.
SOURCE: Gayet-Ageron A et al. Lancet. 2017 Nov 7. doi: 10.1016/S0140-6736(17)32455-8
FROM THE LANCET