Traumatic Extra-cranial Bleeding

Each year, worldwide nearly six million people die from trauma – many after reaching the hospital


Among trauma patients who survive to reach the hospital, extra-cranial bleeding is a common cause of death, accounting for around 40% of in-hospital deaths

Research Overview

The CRASH-2 trial of TXA for traumatic haemorrhage

The CRASH-2 trial evaluated the effect of TXA on death and vascular occlusive events in patients with traumatic bleeding.

A total of 20,211 adult trauma patients with significant bleeding, who were within 8 hours of their injury, were randomly allocated to receive TXA (1 g over 10 min followed by an infusion of 1 g over 8 h) or matching placebo.

The CRASH-2 trial results showed TXA significantly reduced all-cause mortality in bleeding trauma patients but should be given as early as possible. Treatment within three hours of injury reduces death due to bleeding by about one-third (Relative Risk (RR) = 0.72 (0.63 – 0.83); p<0.001 ).

There was strong evidence that the effect of TXA on death due to bleeding varied according to the time from injury to treatment.

Early treatment (≤1 h from injury) significantly reduced the risk of death due to bleeding (RR 0.68, 95% CI 0.57-0.82; p<0.0001). Treatment given between 1 and 3 hours also reduced the risk of death due to bleeding (RR 0.79, 0.64-0.97; p=0.03).

Treatment given after 3 h seemed to increase the risk of death due to bleeding (RR 1.44, 1.12-1.84; p=0.004). No increase in vascular occlusive events was observed.

On the basis of these results, tranexamic acid was added to the WHO’s Essential Medicines List and to trauma protocols worldwide.

More Resources

Click on watch, read or teach to access videos, publications, and training materials 

More Treatments

TXAcentral is a resource for health professionals caring for people with acute bleeding
TXAcentral brings together randomised trial evidence on the effectiveness and safety of tranexamic acid
Data on many of the trials are also available at the freeBIRD website

In trauma patients with significant bleeding and those with traumatic brain injury (TBI), TXA has been  shown to reduce mortality in both extracranial and intracranial bleeding

Postpartum Haemorrhage (PPH) is the leading cause of maternal death worldwide, responsible for around 100 000 deaths each year. TXA given as quickly as possible after birth and no later than 3 hours, reduces death due to bleeding and the need for surgery to stop bleeding

GI Bleeding is a common emergency that causes substantial mortality and morbidity worldwide. TXA was found to not reduce deaths from GI bleeding and showed an increased risk of thromboembolic events

Every year there are over 300 million surgical procedures worldwide. Bleeding is an important complication and many patients require a blood transfusion. TXA reduces blood loss in surgical patients by about one‐third. However, the effects of TXA on thromboembolic events and mortality in surgery are uncertain

There is ongoing research looking at how Tranexamic Acid (TXA) could be utilised for other bleeding conditions