For the past two weeks Twitter journal club has looked at two fairly old but still very relevant papers. The paper chosen for this week is at the cutting edge of research and recently won the award for Research Paper of the Year at the 2011 BMJ Awards. This award recognises a paper that the judges believe will have an impact on doctors and patients over the next 5 to 10 years.
The results of CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage) were published in The Lancet in June 2010. This was a randomised placebo controlled trial which recruited 20,211 trauma patients with, or at risk of significant haemorrhage in 274 hospitals in 40 countries. Patients were randomised into two arms of the study – either to receive placebo or the drug tranexamic acid. Tranexamic acid is an antifibrinolytic, this drug works by blocking sites on an enzyme that causes blood clot breakdown. The trial was designed to assess whether early administration of this treatment (within eight hours) would have an impact on patient deaths due to bleeding.
The headline finding – all-cause mortality was significantly reduced with tranexamic acid (14.5% in the treatment group vs 16.0% in the placebo group – relative risk 0·91, 95% CI 0·85—0·97; p=0·0035). Risk of death due to bleeding was also significantly reduced (4·9% in the treatment group vs 574 5·7% in placebo group ; relative risk 0·85, 95% CI 0·76—0·96; p=0·0077).
“Our research showed that giving tranexamic acid to bleeding trauma patients is both effective and cost effective. These findings are of global importance because every year, over 2 million people die from traumatic haemorrhage”
A very simple intervention with a relatively inexpensive drug that could have a global impact on the mortality of trauma victims worldwide – this is why we have chosen to discuss CRASH-2 in this week’s journal club.
I will be posting a list of discussion points in advance of the journal club on Sunday at 8pm BST. I am very excited to have the opportunity to critique this paper and look forward to another interesting and informative discussion.