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Bafut District Hospital, Cameroon \n Fundong District Hospital, Cameroon \n St John of God Medical Centre, Cameroon \n Hamilton General Hospital, Renji Hospital, China \n Hospital Universitário San Vicente de Paúl, Universidad de Antioquia, Colombia \n Hospital Universitário, San Jose de Popayan, Colombia \n Hospital Pablo Tobon Uribe, Colombia \n Hospital San Andrés de Tumaco, Colombia \n Fundación Clínica Valle del Lili, Colombia \n Clínica las Americas, Colombia \n Hospital General de Medellin, Colombia \n Hospital San Felix ESE, Colombia \n Hospital Universitário del Caribe, Colombia \n Hospital Universitário San Jorge, Colombia \n Hospital San Rafael Tunja, Colombia \n Clínica La Estancia SA, Colombia \n Fundación Hospital San José de Buga, Colombia \n Hospital Civil de Ipiales, Colombia \n Hospital Universitário Departamental Nariño, Colombia \n Hospital Universitário del Valle, Colombia \n Hospital Universitário de Neiva, Colombia \n Hospital Manuel Uribe Ángel, Colombia \n Hospital Clínico-Quirúrgico Docente Saturnino Lora, Cuba \n Hospital General Universitário Carlos Manuel de Céspedes, Cuba \n Hospital Provincial Docente Manuel Ascunce Domenech, Cuba \n Hospital Universitário Arnaldo Milián Castro, Cuba \n Hospital Universitário Dr Gustavo Aldereguía Lima, Cuba \n Hospital Abel Santamaría Cuadrado, Cuba \n Hospital Miguel Enríquez, Cuba \n Hospital General Calixto García, Cuba \n Hospital Antonio Luaces Iraola, Cuba \n Hospital Provincial Docente VI Lenin, Cuba \n Research Institute for Special Surgery and Trauma, Czech Republic \n Hospital Luis Vernaza, Ecuador \n Hospital José Carrasco Arteaga, Ecuador \n Hospital de Niños Dr Roberto Gilbert Elizalde, Ecuador \n Hospital Naval Guayaquil, Ecuador \n Hospital Alcivar, Ecuador \n Hospital Dr Rafael Rodríguez Zambrano, Ecuador \n Clínica De Especialidades Medicas San Gregorio, Ecuador \n Mataria Teaching Hospital, Egypt \n Suez Canal University, Egypt \n Aswan Teaching Hospital, Egypt \n Hospital Nacional Rosales, El Salvador \n Tbilisi State University Clinical Hospital 'I Javakhishvili', Georgia \n Tbilisi First Hospital, University Clinic, Neurosurgery Center, Georgia \n Tbilisi City Hospital, Tbilisi State Medical University ER Department, Georgia \n Institute of Critical Care Medicine, Georgia \n Korle Bu Teaching Hospital, Ghana \n Nyinahin Government Hospital, Ghana \n Sogakope District Hospital, Ghana \n Methodist Hospital, Ghana \n WenchiEffia Nkwanta Regional Hospital, Ghana \n Saint Theresa's Hospital, Ghana \n Medical Trust Hospital Kochi, India \n Christian Medical College Ludhiana, India \n Aditya Neuroscience Centre, India \n Sri Sai Hospital, India \n Care Hospital, India \n North Bengal Neuro Research Centre, India \n Sheth VS General Hospital and NHL Municipal College, India \n LTM Medical College and General Hospital, India \n Government Medical College and Associated Hospitals Jammu, India \n MKCG Medical College, India \n Christian Medical College Hospital Vellore, India \n KLE Hospital and Medical Research Centre, India \n NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, India \n Sanjivani Diagnostics and Hospital, India \n Parkar Hospital, India \n Jeevan Jyoti Hospital and Research Centre, India \n Mansarovar Hospital, India \n Postgraduate Institute of Medical Science Rohtak, India \n Goyal Hospital Jalna, India \n Government Medical College Chandigarh, India \n Oberai Hospital, India \n Rajeev Gandhi Memorial Hospital and Research Centre, India \n Calicut Medical College Hospital, India \n Krishnamai Medical and Research Foundation's NIKOP Hospital, India \n St Stephen's Hospital, India \n Government Rajaji Hospital, India \n Medical College Trivandrum, India \n Sanjeevani Hospital, India \n Kamineni Hospital, India \n Sri Sakthi Hospital, India \n Bhattacharya Orthopaedic and Related Research Centre, India \n Sushrut Hospital, India \n All India Institute of Medical Sciences, India \n GM Hospital (P) LTD, India \n Government Medical College and Superspeciality Hospital Nagpur, India \n Government Medical College New Civil Hospital, India \n Chikitsa Hospital, India \n Apollo Health City, India \n Apex Neurotrauma and Superspeciality Hospital, India \n Neuro Center Gola Ghat, India \n NSCB Medical College, India \n BGS Global Hospital, India \n Chettinad Hospital and Research Institute, India \n Sir Sayajirao General Hospital and Medical College Baroda, India \n Goyal Hospital and Research Centre Jodhpur, India \n Krishna Surgical Hospital, Trauma Care Centre, India \n Nizam's Institute of Medical Sciences, India \n Niramay Hospital, India \n Apex Hospital Bhopal, India \n Dr Jeyasekharan Medical Trust, India \n Himalayan Institute of Medical Sciences, India \n Apollo Gleneagles Hospitals, India \n Civil Hospital Gandhinagar, India \n Sukhdev Raj Soin Hospital, India \n Sancheti Institute for Orthopaedics and Rehabilitation, India \n St James Hospital, India \n Al Shifa Hospital, India \n Anant Institute of Medical Sciences, India \n Vinayaka Mission Hospital, India \n Gauhati Medical College and Hospital, India \n Krishna Hospital and Medical Research Centre, India \n Ruby Hall Clinic, India \n Shreejee Hospital, India \n Nazareth Hospital, India \n Ganga Hospital, India \n Vadamalayan Hospitals, India \n Devadoss Multispeciality Hospital, India \n KIOT Hospital, India \n Baby Memorial Hospital, India \n Bethany Hospital, India \n Suretech Hospital and Research Centre, India \n Surya Hospital, India \n Apollo Clinic Varanasi, India \n Fortis Escorts Hospital, India \n Gokul Hospital and Trauma Centre, India \n International Hospital Assam, India \n Lifeline Multispeciality Hospital, India \n Meenakshi Mission Hospital and Research Centre, India \n MOSC Medical College Hospital, India \n MS Ramaiah Memorial Hospital, India \n Saykhedkar Hospital and Research Centre, India \n Shanti Mukand Hospital, India \n Shri KM Memorial Jain Heart and General Hospital, India \n Usha Hospital, India \n Soebandi Hospital Jember, Indonesia \n Sanglah General Hospital, Indonesia \n Saiful Anwar General Hospital, Indonesia \n Dr Soetomo General Hospital, Indonesia \n Cipto Mangunkusumo Hospital, Indonesia \n Muhammadiyah Lamongan Hospital, Indonesia \n Nemazi Hospital, Iran \n Erfan Hospital, Iran \n Loqman Medical Center, Iran \n Imam Hosain Hospital, Iran \n Diwaniyah College of Medicine, Iraq \n Spedali Civili di Brescia, Italy \n Azienda Ospedaliera Di Parma, Italy \n University Hospital of the West Indies, Jamaica \n Fukuoka University Hospital, Japan \n Kenyatta National Hospital, Kenya \n Kapenguria District Hospital, Kenya \n Hospital University Science Malaysia, Malaysia \n Sungai Buloh Hospital, Malaysia \n University of Malaya Medical Centre, Malaysia \n Hospital Tengku Ampuan Rahimah, Malaysia \n Ampang Hospital, Malaysia \n Hospital General Regional 25, Mexico \n Hospital Gustavo Rovirosa, Mexico \n Hospital General de Uruapan Dr Pedro Daniel Martínez, Mexico \n Hospital General Ecatepec Las Américas, Mexico \n Hospital General La Perla, Mexico \n Hospital General de Ecatepec Dr José María Rodríguez, Mexico \n National Hospital Abuja, Nigeria \n University of Benin Teaching Hospital, Nigeria \n Obafemi Awolowo University Teaching Hospitals, Nigeria \n Irrua Specialist Teaching Hospital, Nigeria \n Olabisi Onabanjo University Teaching Hospital, Nigeria \n University College Hospital Ibadan, Nigeria \n Ahmadu Bello University Teaching Hospital, Nigeria \n Baptist Medical Centre, Nigeria \n University of Ilorin Teaching Hospital, Nigeria \n Enugu State University Teaching Hospital, Nigeria \n LAUTECH Teaching Hospital, Nigeria \n Federal Medical Centre Makurdi, Nigeria \n Nnamdi Azikiwe University Teaching Hospital, Nigeria \n Lagos State University Teaching Hospital, Nigeria \n Usmanu Danfodiyo University Teaching Hospital, Nigeria \n National Orthopaedic Hospital Enugu, Nigeria \n University of Calabar Teaching Hospital, Nigeria \n University of Abuja Teaching Hospital, Nigeria \n University of Uyo Teaching Hospital, Nigeria \n Federal Medical Centre Yenagoa, Nigeria \n Seventh Day Adventist Hospital, Nigeria \n Federal Medical Centre Birnin-Kebbi, Nigeria \n Abia State University Teaching Hospital, Nigeria \n Wesley Guild Hospital, Nigeria \n Federal Medical Centre Umuahia, Nigeria \n University of Maiduguri Teaching Hospital, Nigeria \n National Orthopaedic Hospital Igbobi, Nigeria \n University of Nigeria Teaching Hospital Enugu, Nigeria \n Hospital Regional Docente de Trujillo, Peru \n Hospital Nacional Hipolito Unanue, Peru \n Clinica Santa Ana, Peru \n Hospital La Caleta, Peru \n Hospital Nacional Sergio E Bernales, Peru \n Hospital de Apoyo de Sullana, Peru \n Hospital IV Essalud Huancayo, Peru \n Hospital Nacional Arzobispo Loayza, Peru \n Hospital Municipal Los Olivos, Peru \n Hospital Jose Cayetano Heredia, Peru \n Hospital Nacional Carlos Alberto Seguin Escobedo, Peru \n Hospital Nacional Dos De Mayo, Peru \n Hospital Nacional Cayetano Heredia, Peru \n King Khalid University Hospital, Saudi Arabia \n King Khalid National Guard Hospital, Saudi Arabia \n Klinicki Centar Srbije, Serbia \n National Neuroscience Institute, Singapore \n FNsP Ružinov, Slovakia \n NsP Poprad, Slovakia \n NsP JA Reiman Hospital, Slovakia \n Faculty Hospital F D Roosevelta, Slovakia \n Dr George Mukhari Hospital, South Africa \n George Provincial Hospital, South Africa \n Hospital Universitário Virgen del Roció, Spain \n Hospital Ramón y Cajal de Madrid, Spain \n Hospital Universitário Germans Trias i Pujol, Spain \n Hospital Torrecardenas, Spain \n Hospital Universitário Virgen de la Victoria, Spain \n National Hospital of Sri Lanka, Sri Lanka \n Muhimbili Orthopaedic Institute, Tanzania \n Khon Kaen Regional Hospital, Thailand \n Pattani Hospital, Thailand \n Suratthani Hospital, Thailand \n Bhumibol Adulyadej Hospital, Thailand \n Lampang Hospital, Thailand \n Rayong Hospital, Thailand \n Roi-Et Hospital, Thailand \n Phrae Hospital, Thailand \n Hospital Habib Thameur, Tunisia \n University Hospital of North Staffordshire, United Kingdom \n Royal London Hospital, United Kingdom \n Leicester Royal Infirmary, United Kingdom \n Nottingham University Hospitals NHS Trust, United Kingdom \n Frenchay Hospital, United Kingdom \n Countess of Chester Hospital, United Kingdom \n Hull Royal Infirmary, United Kingdom \n Royal Sussex County Hospital, United Kingdom \n Derby Hospitals NHS Trust, United Kingdom \n Bedford Hospital NHS Trust, United Kingdom \n Royal Liverpool University Hospital, United Kingdom \n Colchester General Hospital, United Kingdom \n Royal Lancaster Infirmary, United Kingdom \n Worthing Hospital, United Kingdom \n Darent Valley Hospital, United Kingdom \n Hope Hospital, United Kingdom \n Northern General Hospital, United Kingdom \n University Teaching Hospital, Lusaka, Zambia \n Nchanga North General Hospital, Zambia \n Cited By :1609 \n Export Date: 2 July 2020 \n CODEN: LANCA \n Funding details: Health Technology Assessment Programme, HTA \n Funding details: Bupa Foundation \n Funding text 1: Telephone randomisation system, unblinding, and adverse event reporting service was provided by the CTSU, University of Oxford, Oxford, UK. Randomisation codes were generated by Alan Young of CTSU. The London School of Hygiene and Tropical Medicine supported the core trial coordinating staff during the first year of the trial set-up. Funding for the run-in stage was provided by J P Moulton Charitable Foundation and the BUPA Foundation. A grant-in-aid for purchasing the tranexamic acid and placebo was provided by Pfizer. The main phase of this trial was funded by the UK NIHR Health Technology Assessment programme and will be published in full in the Health Technology Assessment journal series. 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"abstractText" : "Background Tranexamic acid can reduce bleeding in patients undergoing elective surgery. We assessed the effects of early administration of a short course of tranexamic acid on death, vascular occlusive events, and the receipt of blood transfusion in trauma patients. Methods This randomised controlled trial was undertaken in 274 hospitals in 40 countries. 20 211 adult trauma patients with, or at risk of, significant bleeding were randomly assigned within 8 h of injury to either tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo. Randomisation was balanced by centre, with an allocation sequence based on a block size of eight, generated with a computer random number generator. Both participants and study staff (site investigators and trial coordinating centre staff ) were masked to treatment allocation. The primary outcome was death in hospital within 4 weeks of injury, and was described with the following categories: bleeding, vascular occlusion (myocardial infarction, stroke and pulmonary embolism), multiorgan failure, head injury, and other. All analyses were by intention to treat. This study is registered as ISRCTN86750102, Clinicaltrials.gov NCT00375258, and South African Clinical Trial Register DOH-27-0607-1919. Findings 10 096 patients were allocated to tranexamic acid and 10 115 to placebo, of whom 10 060 and 10 067, respectively, were analysed. All-cause mortality was significantly reduced with tranexamic acid (1463 [14·5%] tranexamic acid group vs 1613 [16·0%] placebo group; relative risk 0·91, 95% CI 0·85-0·97; p=0·0035). The risk of death due to bleeding was significantly reduced (489 [4·9%] vs 574 [5·7%]; relative risk 0·85, 95% CI 0·76-0·96; p=0·0077). Interpretation Tranexamic acid safely reduced the risk of death in bleeding trauma patients in this study. On the basis of these results, tranexamic acid should be considered for use in bleeding trauma patients. 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