The sooner tranexamic acid is administered for hemorrhage, the better, according to an analysis of 40,138 patients with severe traumatic or postpartum bleeding.

Immediate treatment improved survival by more than 70% (odds ratio, 1.72; 95%; confidence interval, 1.42-2.10; P less than .0001), but the survival benefit decreased by 10% for every 15 minutes of treatment delay until hour 3, after which there was no benefit with tranexamic acid.

“Even a short delay in treatment reduces the benefit of tranexamic acid administration. Patients must be treated immediately,” said investigators led by Angele Gayet-Ageron, MD , PhD, of University Hospitals of Geneva.

“Trauma patients should be treated at the scene of injury and postpartum hemorrhage should be treated as soon as the diagnosis is made. Clinical audit should record the time from bleeding onset to tranexamic acid treatment, with feedback and best practice benchmarking,” they said in the Lancet .

The team found no increase in vascular occlusive events with tranexamic acid and no evidence of other adverse effects, so “it can be given safely as soon as bleeding is suspected,” they said.

Antifibrinolytics like tranexamic acid are known to reduce death from bleeding, but the effects of treatment delay have been less clear. To get an idea, the investigators ran a meta-analysis of subjects from two, large randomized tranexamic acid trials, one for trauma hemorrhage and the other for postpartum hemorrhage .

There were 1,408 deaths from bleeding among the 40,000-plus subjects. Most of the bleeding deaths (63%) occurred within 12 hours of onset; deaths from postpartum hemorrhage peaked at 2-3 hours after childbirth.

The authors had no competing interests. The trials were funded by the Britain’s National Institute for Health Research and Pfizer, among others.

SOURCE: Gayet-Ageron A et al. Lancet. 2017 Nov 7. doi: 10.1016/S0140-6736(17)32455-8