severe acute episode of bleeding can be fatal if not controlled immediately.
Bleeding may occur due to trauma like an accident or surgery, or due to a
disease condition affecting the blood or an organ. While an external bleed is
often treated urgently, an internal bleed like around the brain or in the
digestive tract is difficult to detect early and can be more dangerous; the
patient can collapse suddenly. Blood transfusions
are administered to replace
the lost blood; however, blood for transfusion is not always easy to obtain.
‘Tranexamic acid improves survival outcomes in patients with bleeding due to trauma or childbirth when administered within three hours of the onset of the bleed.’
a bleed occurs, the platelets in the blood first form a plug. The clot is then
fortified by the activation of certain proteins in the blood called clotting
factors to form a firm clot that stops the bleeding. The blood also contains a
protein that is fibrinolytic i.e. that can break down the clot.
Anti-fibrinolytic drugs like tranexamic acid, aminocaproic acid
stabilize the clot. They have been used to reduce bleeding following surgery or
following delivery. Tranexamic acid
is available as tablets for the
treatment of heavy menstrual bleeding in women.
Scientists studied the
data obtained from two published clinical trials (CRASH-2 and WOMAN) to
understand the survival benefits and the consequences of delaying treatment
with anti-fibrinolytic drugs
. Clinical trials assessed more than 40138
patients with acute severe bleeding due to trauma or following childbirth. The
scientists found that
Thus, as noted from the
study, it is important to start the treatment with tranexamic acid as soon as
possible so that the patient can reap the maximum benefit of the treatment
before tissue damage occurs
- Forty percent of deaths in the studies were due to
bleeding. Around 63 percent of
these deaths occurred within 12 hours of the onset of bleeding. In
fact, deaths following childbirth most commonly occurred 2 to 3 hours
- The administration of tranexamic acid increased
survival following the bleeding. When
the treatment was administered immediately after bleeding, the survival
improved by 70%.
- The benefits of survival reduced when the treatment was
delayed. Even a small delay reduced its effectiveness. The effectiveness reduced by 10% for a
delay of every 15 minutes till 3 hours following the onset of bleeding.
Beyond 3 hours, no benefit was noted.
- Tranexamic acid did not appear to be associated with
significant serious adverse effects. It
did not increase the chances of adverse events like heart attack, stroke,
pulmonary embolism and deep vein thrombosis due to intravascular clot
. It should be readily available to patients at
accident sites or in maternity wards. The results of other ongoing trials will
hopefully throw more light on the benefits of this drug.
- Gayet-Ageron et al. Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients. The LancetDOI: http://dx.doi.org/10.1016/S0140-6736(17)32455-8