原创力文档avoidable mortality from giving tranexamic acid to bleeding trauma patients an estimation based on who mortality data, a systematic literature review and data from the crash-2 trial可避免死亡率提供氨甲环酸估计基于出血创伤病人死亡率数据,一个系统的文献回顾从crash-2试验和数据.pdfVIP
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avoidable mortality from giving tranexamic acid to bleeding trauma patients an estimation based on who mortality data, a systematic literature review and data from the crash-2 trial可避免死亡率提供氨甲环酸估计基于出血创伤病人死亡率数据,一个系统的文献回顾从crash-2试验和数据
Ker et al. BMC Emergency Medicine 2012, 12:3
/1471-227X/12/3
RESEARCH ARTICLE Open Access
Avoidable mortality from giving tranexamic acid
to bleeding trauma patients: an estimation based
on WHO mortality data, a systematic literature
review and data from the CRASH-2 trial
*
Katharine Ker , Junko Kiriya, Pablo Perel, Phil Edwards, Haleema Shakur and Ian Roberts
Abstract
Background: The CRASH-2 trial showed that early administration of tranexamic acid (TXA) safely reduces mortality
in bleeding in trauma patients. Based on data from the CRASH-2 trial, global mortality data and a systematic
literature review, we estimated the number of premature deaths that might be averted every year worldwide
through the use of TXA.
Methods: We used CRASH-2 trial data to examine the effect of TXA on death due to bleeding by geographical
region. We used WHO mortality data (2008) and data from a systematic review of the literature to estimate the
annual number of in-hospital trauma deaths due to bleeding. We then used the relative risk estimates from the
CRASH-2 trial to estimate the number of premature deaths that could be averted if all hospitalised bleeding
trauma patients received TXA within one hour of injury, and within three hours of injury. Sensitivity analyses were
used to explore the effect of uncertainty in the parameter estimates and the assumptions made in the model.
Results: There is no evidence that the effect of TXA on death due to bleeding varies by geographical region
(heterogeneity p = 0.70). Based on WHO data and our systematic literature review, we estimate that each year
worldwide there are approximately 400,000 in-hospital trauma deaths due to bleeding. If patients received TXA
within one hour of injury then approximately 128,000 (uncertainty range [UR] ≈ 72,000 to 172,000) deaths might
be ave
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