- Design
- Single-centre retrospective cohort with 1:1 propensity matching
- Population
- 1,408 adult trauma patients given tranexamic acid within 3 hours (335 matched pairs)
- Primary outcome
- In-hospital mortality
- Effect
- 14.0% bolus only vs 17.3% bolus plus infusion; aOR 1.29 (95% CI 0.84 to 1.97)
The CRASH-2 regimen gives tranexamic acid as a 1 g bolus followed by a 1 g infusion over eight hours, and the infusion is often missed in a busy resuscitation. This retrospective study at a Korean regional trauma centre compared 1,408 patients treated within three hours of injury: 409 had the bolus only and 999 the full regimen. After propensity matching, 335 pairs remained.
In-hospital mortality was 14.0% with bolus alone and 17.3% with bolus plus infusion (adjusted OR 1.29, 95% CI 0.84 to 1.97), with no significant difference at 24 hours or 28 days.
The finding is reassuring for a patient whose infusion was not started, but a single-centre retrospective cohort cannot show that the infusion is unnecessary.
Keep giving the full regimen. If the infusion is delayed or missed, the bolus within three hours is the part that most clearly matters.
- Give tranexamic acid within three hours of injury in bleeding trauma patients
- Continue to prescribe the 1 g infusion over eight hours after the bolus
- Prioritise the bolus if resuscitation is chaotic
- Prospective data are needed before dropping the infusion
Why it matters
It offers some reassurance when the infusion is missed, a common gap in resuscitation.
Don't overread it
A single-centre retrospective comparison cannot show the infusion adds nothing.
The statistics, in plain English
The odds ratio of 1.29 has a confidence interval from 0.84 to 1.97, crossing 1.0, so the data are compatible with no difference, some harm or some benefit from dropping the infusion.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for general surgery, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free