These authors review the literature regarding TXA and it’s cost/risk/benefit for hemostatic control of injured trauma patients. Of course, this specifically means they review the single significant piece of literature for TXA – the CRASH-2 trial published in the Lancet.
I’m not sure I entirely agree with their premise that TXA is safer because it is just an antifibrinolytic rather than an activator of clotting/platelet aggregation – clot formation and breakdown is a dynamic process and any interference in that system carries a risk. But, they do a fairly detailed look at TXA and the CRASH-2 trial, and I think they make a fair and defensible point that, while the NNT is pretty high, it is a fairly low cost intervention with a relevant outcome variable of overall mortality.
While a study with 20,000 patients is a nice start, I’d still like to see at least one other prospective study replicating similar results with an appropriate safety analysis.
“Tranexamic Acid for Trauma Patients: A Critical Review of the Literature”
www.ncbi.nlm.nih.gov/pubmed/21795884