BY SOLA OGUNDIPE
A GROUP of Nigerian researchers say the lives of thousands of victims of road traffic accidents, violence, and other forms of injuries that cause severe traumatic bleeding, could be saved each year in the country, with the application of an inexpensive drug utilised for treatment of heavy menstrual periods in women.
Spokesperson of the group, Dr. Adefemi Afolabi of the University College Hospital, Ibadan, Oyo State, however noted that the drug in question, called Tranexamic acid, TXA, (also known as Cyklokapron), is best administered within the first hour after injury to prevent fatal bleeding. He said the drug, which works by increasing clot formation, is essentially useful in stopping severe blood loss caused by traumatic injuries, as suggested by a CRASH- study carried out recently by a global network of researchers. Afolabi who noted that new analysis of the CRASH-2 trial shows that rapid treatment – preferably within an hour of injury – dramatically reduces deaths from bleeding in injured patients, argued that the discovery had significant implications for Nigerian patients.
The discovery, published in The Lancet, highlights importance of early drug treatment to save lives in severe traumatic bleeding. It stressed the importance of an hour as the difference between life and death when using tranexamic acid to treat injured patients with severe bleeding.
“In patients with severe bleeding whether from accidents or violence, rapid treatment with tranexamic acid is vital – an hour could mean a lifetime. The implication of this for the Nigerian health care delivery system is the urgent need to make tranexamic acid readily available and to transfer injured patients rapidly to hospitals where this life-saving drug can be administered within one hour of injury.”
Afolabi, who spoke on behalf of the researchers in Nigeria, stated: “These results show that early administration of tranexamic acid is critical – they have major implications for trauma care provision not only in Nigeria but worldwide.” Describing Tranexamic acid as “an old drug “ he said it is widely available in India. “It has been used to treat heavy bleeding such as heavy menstrual periods, nose bleeds, prevention of bleeding during tooth extraction in haemophiliacs (people who lack a clotting factor) and for reducing excess fluid around the body.
“Only recently with the completion of the large international CRASH-2 trial has it become know that it can save lives in severe traumatic bleeding,” he submitted.
From the findings, approximately 10, 500 people die in Nigeria every year from severe injury related bleeding. “Giving tranexamic acid to patients within the first hour of injury could save the lives of over 1, 500 patients every year. It is vital that patients with severe bleeding following injuries are taken to hospital as quickly as possible to receive this treatment
early. If treatment is delayed beyond three or four hours after the injury, it is unlikely to be effective and might even be harmful, the research shows.”
The CRASH-2 trial involved 20,211 adult trauma patients in 40 countries with, or at risk, of significant bleeding who were randomly assigned to either tranexamic acid or a placebo within eight hours of injury.
Over 2,000 patients from 28 hospitals in Nigeria participated in this research which was coordinated nationally by Dr. Edward Komolafe of the Obafemi Awolowo University Teaching Hospital (OAUTH), Ile-Ife, Osun State.
The original trial first published in the Lancet in June 2010, found that administration of tranexamic acid – which reduces clot breakdown and is used to treat heavy menstrual periods – reduced mortality by around 10 percent. However, in the latest analysis, the authors looked at subgroups of patients who had received tranexamic acid within an hour of the injury; between one and three hours; or more than three hours, in order to explore the relationship between timing of administration of the drug and its effect.
Findings showed that early treatment (within an hour of injury) reduced the risk of death due to bleeding by more than 30 percent. Treatment given between one and three hours cut the risk of bleeding death by 20 percent but there was no benefit if treatment was delayed beyond 3 or 4 hours.