Cheap drug could save tens of thousands of accident victims by stopping bleeding
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An inexpensive drug could save tens of thousands of lives lost in accidents and war every year by minimizing excessive bleeding, British researchers reported Monday. The drug, called tranexamic acid, is already used during surgeries in many developed countries to prevent unwanted bleeding, but the results from a massive clinical trial reported in the journal Lancet indicate that it could be used on an everyday basis even in the poorest countries. Physicians had feared that such widespread use of the drug might lead to heart attacks, embolisms or other problems resulting from clot formation, but the new study showed an excellent safety profile for the drug.
For people ages 5 to 45, injuries due to accidents are second only to HIV/AIDS as a cause of death worldwide. Overall, road traffic accidents are the ninth-leading cause of death and they are expected to climb to third by 2020 as more people in developing countries own cars. More than 90% of trauma deaths occur in low-income countries.
Tranexamic acid, a simple synthetic derivative of the naturally occurring amino acid lysine, interferes with the natural process by which the body’s cardiovascular system breaks down potentially dangerous clots. That system can be beneficial when a clot forms as the result of plaque, for example, but it can also inhibit clot formation in the case of excessive bleeding. Epidemiologist Ian Roberts of the London School of Hygiene and Tropical Medicine and his colleagues reasoned that the drug might thus be useful in accidents to minimize bleeding.
They organized a trial that enrolled more than 20,000 accident victims at 274 hospitals in 40 countries. Participants were randomly chosen to receive either a 1-gram dose of tranexamic acid and another gram over the next eight hours, or a placebo given the same way.
They found that, in the four months after the accident, tranexamic acid reduced deaths from all causes by 10% compared with the placebo and the risk of death from excessive bleeding by 15%. There was no increase of any complications that might be caused by excessive clot formation.
‘This is one of the cheapest ways ever to save a life,’ Roberts said at a London news conference. The drug costs only about $4.50 per gram. ‘In many developing countries, emergency departments are like war zones, even when there is no war. If [tranexamic acid] is available, a lot of those deaths could be avoided.’
The researchers estimated that the drug could save about 100,000 lives around the world each year, including 13,000 in India, 12,000 in China, 2,000 in the United States and about 280 in Britain.
Last week, Roberts and his colleagues submitted a petition to the World Health Organization for tranexemic acid to be included on its list of essential medicines, which would allow many charitable groups to purchase it for developing countries.
The study was funded primarily by Britain’s National Institute for Health Research. The drug is off-patent and readily available as a generic.
-- Thomas H. Maugh II
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