Life-saving drug should be given more widely in UK hospitals – new study

Posted by hct16 at Nov 19, 2012 10:47 AM |
Inexpensive treatment cuts risk of bleeding to death by 30 per cent

Issued by University of Leicester Press Office 19 November 2012

Photograph of Professor Tim Coats available from pt91@le.ac.uk

A new approach to treating injured patients could save 150 lives a year, according to a study involving over 13,000 patients.

The research into the administering of a simple and inexpensive treatment to patients who are injured and bleeding is being recommended to doctors in A&E units across the UK.

The research funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme  identified that a drug, tranexamic acid, should be used across the spectrum of injured patients who are bleeding - not just those with the most severe bleeding.

The new study published in the BMJ, analyses data from the CRASH-2 trial,  demonstrating that  the drug could lower the risk of injury victims bleeding to death by up to 30 per cent.  The treatment is used by the military on injured soldiers – but the latest study highlights the need to increase the use of the drug on civilians in UK hospitals.

Professor Ian Roberts, Professor of Epidemiology at the London School of Hygiene & Tropical Medicine, the corresponding author on the study, said: “Tranexamic acid is safe and effective and is one of the cheapest ways to save a life in the whole of healthcare - the challenge now is to ensure that patients who can benefit from it get it."

Professor Tim Coats, Professor of Emergency Medicine at the University of Leicester, who was one of the principal investigators, added: “At present in the UK, tranexamic acid is not used on the less severely injured patients - this approach is costing approximately 150 lives per year in the UK.

“In 2013 the NHS has made the use of tranexamic acid one of the performance measures for the newly formed Major Trauma Networks, so we are hoping that doctors in the UK will increasingly use this treatment for all injured patients.”

Tranexamic Acid helps to promote blood clotting. It works by preventing the body from breaking down bloodclots and is used in situations where there is or could be excessive bleeding. The new research has revealed that it is effective for those whose bleeding is less severe if administered within three hours of injury.

Researchers from the London School of Hygiene and Tropical Medicine, the University of Leicester, Guy’s and St Thomas’ NHS Foundation Trust, University of Sheffield, Queen Mary University, London, University of Oxford and the Nuffield Orthopaedic Centre, Oxford were involved in the study published in The Lancet and the British Medical Journal.

The authors state: “These results have important implications for the care of trauma patients. Firstly, they suggest that tranexamic acid can safely be used in all trauma patients with or at risk of severe bleeding and not just in the most severely injured.

“Secondly, the observed reduction in the risk of arterial events with tranexamic acid suggests that the absolute benefits from administration of tranexamic acid are likely to be greatest in older trauma patients, who at any given level of severity of injury have a higher baseline risk of death from haemorrhage and thrombotic events.

“Clinical concern about an increased risk of ischaemic cardiac events might be a reason to give rather than to withhold tranexamic acid. It is worth noting that trials of tranexamic acid in patients undergoing cardiac surgery, a group at high risk of cardiac events, provide no evidence of any increased risk.

“We acknowledge that estimating the risk of severe bleeding is a challenging ongoing process that uses not only physiological variables but other variables such as laboratory measurements  and response to treatments. Physicians will use all this information and their clinical judgment when deciding whether to use tranexamic acid. In situations of uncertainty, however, physicians can use the prognostic model to support the decision making process and should certainly consider administering tranexamic acid to patients with a risk of death higher than 5%.”

The study was funded by the National Institute for Health Research Health Technology Assessment Programme (09/22/165) and will be published in full in the Health Technology Assessment journal series.

ENDS

Background information and guidance for UK Emergency Physicians: http://www.le.ac.uk/txa

The latest BMJ paper: http://www.bmj.com/content/345/bmj.e5839

Lancet papers:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60278-X/abstract

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60835-5/abstract

 

1. The National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme funds research about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest NIHR programme and publishes the results of its research in the Health Technology Assessment journal, with over 600 issues published to date. The journal’s 2011 Impact Factor (4.255) ranked it in the top 10% of medical and health-related journals. All issues are available for download, free of charge, from the website. The HTA Programme is funded by the NIHR, with contributions from the CSO in Scotland, NISCHR in Wales, and the HSC R&D Division, Public Health Agency in Northern Ireland.www.hta.ac.uk.

2. The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (www.nihr.ac.uk).

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Email: pressoffice@le.ac.uk

About the London School of Hygiene & Tropical Medicine

The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with 4000 students and more than 1300 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, and was recently cited as one of the world’s top universities for collaborative research.  The School's mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice. www.lshtm.ac.uk<http://www.lshtm.ac.uk>

 

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