Trauma and tranexamic acid

Russell L Gruen, Ian G Jacobs and Michael C Reade, on behalf of the PATCH-Trauma study investigators*
Med J Aust 2013; 199 (5): 310-311. || doi: 10.5694/mja13.10747

Research is needed to determine how patient selection and intercurrent treatment affect safety and efficacy

Clinicians involved in the resuscitation of severely injured patients face a dilemma. On one hand, since publication of the landmark CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage 2) study in 2010,1 there has been an international push for inclusion of tranexamic acid (TxA) in trauma management protocols. On the other hand, the need for more evidence to solve ongoing knowledge gaps has been emphasised, especially evidence of who benefits and whether anyone is harmed when TxA is administered to patients treated to modern civilian and military trauma standards.2,3 While both views represent well intentioned efforts to improve care, they create conflicting priorities that must be reconciled before patients can properly benefit.

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  • Russell L Gruen1,2
  • Ian G Jacobs3,4
  • Michael C Reade5,6
  • on behalf of the PATCH-Trauma study investigators*

  • 1 The Alfred and Monash University, Melbourne, VIC.
  • 2 National Trauma Research Institute, Melbourne, VIC.
  • 3 Emergency Medicine, University of Western Australia, Perth, WA.
  • 4 St John Ambulance (Western Australia), Perth, WA.
  • 5 Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, QLD.
  • 6 Joint Health Command, Australian Defence Force, Canberra, ACT.



The PATCH-Trauma study is funded by the NHMRC. Russell Gruen is supported by an NHMRC Practitioner Fellowship.

Competing interests:

All three authors are chief investigators in the PATCH-Trauma study.

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  • 2. Pusateri AE, Weiskopf RB, Bebarta V, et al. Tranexamic acid and trauma: current status and knowledge gaps with recommended research priorities. Shock 2013; 39: 121-126.
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  • 8. Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg 2012; 147: 113-119.
  • 9. Mitra B, Cameron PA, Gruen RL. Aggressive fresh frozen plasma (FFP) with massive blood transfusion in the absence of acute traumatic coagulopathy. Injury 2012; 43: 33-37.
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  • 11. Goldberger JJ, Buxton AE. Personalized medicine vs guideline-based medicine. JAMA 2013; 309: 2559-2560.


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