tranexamic acid in trauma by karim brohi

TRANEXAMIC ACID IN TRAUMA

Queen Mary University of Londonwww.c4ts.qmul.ac.uk

Royal London Major Trauma CentreBarts Health NHS Trust

KARIM BROHI, FRCS FRCAProfessor of Trauma Sciences, QMULClinical Director, London Major Trauma System

THETRANEXAMIC ACID

DENIER’SHANDBOOK

THE PROBLEM

60%MASSIVE LYSIS

20,000+ subjects15% mortality RRR

STRATEGY 1DEFLECT THE ISSUE

TRANEXAMIC ACID

TRANEXAMIC ACIDTRAXENAMIC ACIDTRASENAMIC ACIDTAXIDERMIC ACIDTRIXYDIXY ACID

TRANSENEEMIC ACID

STRATEGY 2DISRESPECT THE STUDY

STRATEGY 2DISRESPECT THE STUDYDISRESPECT THE RESULTS

20,000+ subjects15% mortality RRR

20,000+ subjects15% mortality RRR

4.9% vs 5.7%0.8% ARR!!!

20,000+ subjects15% mortality RRR

4.9% vs 5.7%0.8% ARR!!!

NNT: 125

Deaths due to bleeding5.3% vs 7.7%

2.4% ARRNNT: 42

CRASH 2

CRASH 2 - Bleeders

CRASH 2

CRASH 2 - Bleeders

ROYAL LONDONMATTERS

CRASH 2

CRASH 2 - Bleeders

ROYAL LONDONMATTERS

RLH-SHOCKEDMATTERS- MT

STRATEGY 2DISRESPECT THE STUDY

STRATEGY 2DISRESPECT THE STUDY

DISRESPECT THE DESIGN

ISS

PRAGMATIC

STRATEGY 2DISRESPECT THE STUDY

STRATEGY 2DISRESPECT THE STUDY

DISRESPECT THE ETHICS

EQUIPOISE

STRATEGY 2DISRESPECT THE STUDY

STRATEGY 2DISRESPECT THE STUDYDISRESPECT THE SUBJECTS

STRATEGY 2DISRESPECT THE STUDY

STRATEGY 2DISRESPECT THE STUDY

DISRESPECT THE INVESTIGATORS

99% FOLLOW-UP

PANTS ON FIRE

STRATEGY 3SCAREMONGER

STRATEGY 4PUBLISH SOMETHING

(ANYTHING)

TXA INCREASED MORTALITY!

THETRANEXAMIC ACID

DENIER’SHANDBOOK