CRASH-2

Clinical question

In trauma patients with or at risk of significant hemorrhage, does tranexamic acid reduce mortality?

What the trial found

Tranexamic acid given within 8 hours of trauma reduced all-cause mortality, with the benefit for death due to bleeding concentrated in patients treated within 3 hours of injury — later administration showed a diminished, and in subsequent analyses potentially reversed, effect.

Clinical interpretation

CRASH-2 established early tranexamic acid as standard of care in trauma with significant hemorrhage, with the specific, time-dependent finding that earlier administration matters — this is the basis for treating TXA as most beneficial within a 3-hour window rather than a drug with a flat benefit regardless of timing.

Limitations

• Broad, pragmatic inclusion criteria ('significant hemorrhage or risk of') mean not every enrolled patient had confirmed major bleeding.
• Benefit diminishes and may reverse beyond 3 hours from injury — TXA is not supported as a late intervention by this trial.