Tranexamic acid for trauma in the USA: is prejudice a barrier to saving lives?

The CRASH-2 clinical trial results were published in June, 2010. 1 CRASH-2 trial collaboratorsEffects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010; 376: 23-32 Summary Full Text Full Text PDF PubMed Scopus (1970) Google Scholar , 2 CRASH-2 collaboratorsThe importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011; 377: 1096-1101 Summary Full Text Full Text PDF PubMed Scopus (749) Google Scholar Our global collaboration had randomly allocated 20 211 trauma patients from 274 hospitals in 40 countries to receive tranexamic acid, an antifibrinolytic agent to prevent or reduce bleeding, or placebo. Timely tranexamic acid treatment reduced bleeding deaths by nearly one third and without any side-effects. 1 CRASH-2 trial collaboratorsEffects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010; 376: 23-32 Summary Full Text Full Text PDF PubMed Scopus (1970) Google Scholar , 2 CRASH-2 collaboratorsThe importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011; 377: 1096-1101 Summary Full Text Full Text PDF PubMed Scopus (749) Google Scholar We estimated that widespread use of tranexamic acid could prevent more than 120 000 trauma deaths each year worldwide, with 3500 deaths avoided each year in the USA. 3 Ker K Kiriya J Perel P Edwards P Shakur H Roberts I 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. BMC Emerg Med. 2012; 12: 3 Crossref PubMed Scopus (61) Google Scholar Within weeks of publication in 2010, the British Army was using tranexamic acid for treatment of trauma on the battlefield. In 2010, the war in Afghanistan was at its worst with thousands of civilian deaths due to violence and injury. 2010 was also a disastrous year for the US Army in this war with 496 soldiers killed. But the US Army was slow to adopt tranexamic acid.