- Design
- Single-centre retrospective cohort with 1:1 propensity matching
- Population
- 670 matched adult trauma patients given TXA within 3 hours, Korea
- Primary outcome
- In-hospital mortality
- Effect
- 14.0% bolus-only vs 17.3% bolus-plus-infusion; adjusted OR 1.29 (95% CI 0.84–1.97)
The CRASH-2 regimen gives tranexamic acid as a 1 g bolus then a 1 g infusion over eight hours. The infusion is often missed or delayed during resuscitation. A Korean regional trauma centre compared adults given TXA within three hours of injury as a bolus alone or bolus plus infusion, between 2018 and 2023.
After 1:1 propensity matching of 335 pairs, in-hospital mortality was 14.0% with bolus alone and 17.3% with bolus plus infusion (adjusted OR 1.29, 95% CI 0.84–1.97). Twenty-four-hour and 28-day mortality also did not differ.
This is one centre, retrospective, and not powered for equivalence — the absence of a difference is not proof that the infusion is unnecessary. It is reassurance when an infusion is interrupted, not a reason to drop it.
- Give the tranexamic acid bolus within three hours of injury; timing matters more than the regimen.
- Continue to prescribe the infusion as per the CRASH-2 regimen.
- Do not delay the bolus while setting up an infusion.
- Treat a missed infusion as an error to fix, not a reason for alarm.
Why it matters
It suggests the bolus does most of the work, which matters when infusions are hard to run.
Don't overread it
A retrospective matched cohort cannot show bolus-only is equivalent.
The statistics, in plain English
The confidence interval of 0.84 to 1.97 is wide: it fits a modest benefit or nearly double the odds of death. 'No significant difference' here means the study could not tell, not that the regimens are the same.
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