Timely tranexamic acid treatment for trauma victims

Dr Ian Roberts is a long standing Patron and Supporter of RoadPeace. He is campaigning for the use of tranexamic acid (TXA) as a low cost and effective treatment to save the lives of trauma victims.

His work was recently featured in the Daily Mail after it was revealed that lives would have been saved following the Manchester Arena terrorist attack if TXA has been administered to the victims. You can read more  about his research here.

PLEASE TAKE ACTION

RoadPeace is asking all of its members and supporters to write to their MPs to demand that the Department for Health urgently acts to ensure that TXA is given routinely to victims of trauma.  The key points to make are

  • Timely TXA treatment saves lives in victims of road traffic crashes
  • But currently too few patients are getting it and those that get it get it too late.
  • We need to do better and we want the Health Minister to take action on this.

To find out how to contact your local MP, visit Write to Them

We’ve also shared Ian’s letter to Rt Hon Sajid Javid, Secretary of State for Health, which you may also want to share with your MP.

Dear Secretary of State

Ten years ago, a large international clinical trial (the CRASH-2 trial) funded by the UK NIHR showed that an inexpensive generic drug called tranexamic acid (known as TXA) reduces deaths in trauma victims (e.g. victims of road traffic crashes, violence and falls). If given within an hour of injury, TXA cuts bleeding deaths by one third. Importantly, there were no side effects from giving TXA. TXA is the only drug proven to reduce deaths after traumatic injury. However, it has to be given urgently. For every fifteen minutes treatment delay there is a 10% reduction in the survival benefit from giving TXA. This means that it should be given by paramedics at the scene of the injury. Timely treatment of all bleeding trauma patients would prevent hundreds of premature deaths each year in the UK. Nevertheless, ten years after the CRASH-2 trial results were published, only a small fraction of trauma victims receive TXA. Data from UK trauma audit for 2019 (the most recent data available) shows that only 3% of major trauma victims received TXA within an hour of injury and only 6% within 3 hours. This is unacceptable and is resulting in many avoidable deaths.

TXA also has a major role to play in mass casualty events such as the Manchester Arena Bombing. Indeed, I have asked Sir John Saunders who Chairs the Manchester Arena Bombing Inquiry to determine whether paramedics at the scene administered TXA treatment to the blast victims. I doubt that they did. Had they done so then I am sure that someone’s child would still be alive today.

Why is it taking so long for trauma victims in the UK to benefit from this lifesaving treatment? Bearing in mind that TXA is the only proven lifesaving trauma treatment and that time to treatment is critical, please would the Department of Health consider making the receipt of TXA within an hour of injury a clinical quality indicator for the UK ambulance service. I am currently working with the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) to revise the JRCALC guidelines on the use of TXA in trauma to better reflect the current scientific evidence and to implement the use of clear treatment criteria to prevent discrimination against women and older adults. However, without a clear commitment by the Department of Health to improving the situation I am worried that ten years into the future we will be no further ahead.

The use of TXA in mass casualty events in the UK also needs attention. I first advised the government about the need to incorporate TXA into plans for mass casualty events in 2011, just before the London Olympics. A rapid intramuscular injection of TXA given to casualties at risk of death due to bleeding could save many lives. I am currently working with the MOD to develop a TXA autoinjector that could save lives on the battlefield. Such a device would also have a major role in mass casualty events. However, arguably the best way to prepare for such rare but devastating events would be to ensure the incorporation of timely pre-hospital TXA treatment into routine trauma care.

If a patient survives traumatic bleeding they are usually left with no disability and can get on with their lives. There is no scientific debate about the lifesaving benefits of TXA.

The problem is inertia.

The failure to provide this safe, effective, evidence-based treatment to trauma victims is a national scandal and I urge the Department of Health to give this matter the urgent attention it deserves.

Yours sincerely

Dr Ian Roberts MB BCh, FRCP, FPH, PhD

Professor of Public Health, LSHTM

Honorary Consultant, The Royal London Hospital, Barts Health