BGS Global Hospital and MRC London are gearing up to create a mathematical model to help predict the death, disability and other outcomes in bleeding patients taking trauma management to an advanced level of care.
The Bangalore-based 500-bed hospital equipped with an advanced accident trauma centre was the nodal centre from India for the recently concluded multi-centric global Crash-2 clinical trial moderated by MRC, London to assess the efficacy of the tranexamic acid (TXA) injection that helps control fatal bleeding in accident trauma patients.
Globally, 20000 patients from 274 hospitals in 40 countries participated in the study. The trial which is one among the largest has now proved that administration of TXA could save patients with no evidence of adverse side effects and unwanted clotting. BGS, the India nodal centre carried out the study on 60 patients which included cases from two hospitals at Kochi and New Delhi. From BGS alone 32 patients came under the study.
Going by the positive outcome of the TXA study, BGS will promote the protocol of pre-hospital management to save accident victims. One third of the delayed deaths in hospital occur due to bleeding. The study has proved the efficacy of TXA as a life saving drug. Though TXA has been in use for over 3 decades, the clinical trial has proved its importance and indispensability in the first aid kits of ambulances.
The mathematical model will help us to analyze the cases in detail and create protocol format in the area of emergency medicine. We have begun to prescribe TXA at our Trauma Centre and recommending it across medical centres in Karnataka. In addition, efforts to stock TXA at all Comprehensive Trauma Ambulances and ensure its administration on victims at the accident site itself are being made. The drug is inexpensive and easy to administer even by paramedics. Training programmes are being organized on a pilot basis for effective use of this drug and will later be extend it to all as a systematic training module, stated Dr. NK Venkataramana, vice chairman and chief neuro surgeon, BGS Global Hospital, at a press conclave.
The drug TXA is a generic and several multinational companies including Pfizer and Indian pharma majors are engaged in its production. It helps in reducing the clot breakdown. Although this was known to be advantageous in patients with severe bleeding, there was always a doubt whether TXA might increase the risk of complications like heart attacks, stroke and clots in the lung. The results of this large trial show that TXA reduces the death from bleeding without any increase in these complications, he added.
Severely injured adults were enrolled in the trial if they had significant bleeding within a few hours after injury. They were randomly allocated to receive either one gram of TXA injection followed by another one gram by drip over the following eight hours or a matching placebo. The researchers found that TXA had reduced the chances of death die to massive blood loss by about one sixth.
It is estimated that administering TXA soon after injury could save about 12,865 lives each year in India and prevent about one lakh deaths annually world wide. India accounts for accidents every three minutes and one fatal case in every 10 minutes. Currently, trauma is the 11th leading cause of death and it is estimated to become the third common cause of disability by 2020.