Page 44 - Haematologica May 2020

M. Franchini and P.M. Mannucci
with different designs, the results of these trials are very similar and clear: TXA is effective in reducing the risk of death due to bleeding regardless of the cause. Furthermore, all these three trials identified early admin- istration of the drug as a crucial issue for improving patients’ outcome.
Additional striking evidence of the beneficial effect of TXA in acute trauma patients comes from the increasing use of this agent in the military setting.6 Indeed, the pos- itive results of the CRASH-2 trial, conducted in civilian trauma populations, triggered a series of studies evaluat- ing TXA in combat trauma patients.5 The largest trial was the retrospective observational Military Application of Tranexamic Acid in Trauma Emergency Resuscitation study (MATTERs),43 which evaluated TXA in subjects with combat-related injury and found that the addition of
this anti-fibrinolytic agent to blood component-based resuscitation resulted in a survival improvement, particu- larly in patients requiring massive transfusion. Thus, on the basis of the findings from the previously mentioned trials, early administration (within 3 h of injury) of TXA is now globally incorporated as an essential therapeutic strategy in the majority of resuscitation protocols, not only in civilian but also in military trauma centers.
Finally, we would like to outline the safety aspects that emerge from an overall analysis of the various RCT. The risk of thromboembolic events – including pulmonary embolism, deep-vein thrombosis, myocardial infarction and stroke – did not differ between the TXA and placebo groups. These data provide definitive strong evidence demonstrating the safety of TXA and render any residual concern unjustified.
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