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CRASH-2
About the Trial
The Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage trial randomized 20,211 trauma patients with significant bleeding to tranexamic acid or placebo within 8 hours. The antifibrinolytic reduced death from bleeding from 5.7 to 4.9 percent and all cause mortality from 16.0 to 14.5 percent, with no excess of vascular occlusive events. Benefit was greatest when given within 1 hour, and a further analysis suggested treatment after 3 hours was harmful. CRASH 2, run by the London School of Hygiene and Tropical Medicine across 274 hospitals in 40 countries, led to wide adoption of a cheap generic drug in trauma care. WOMAN trial extended the evidence to postpartum hemorrhage. It is a high point of pragmatic global health trial methodology.
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