Each year more than half a million people bleed to death following traffic accidents, combat wounds, and other severe trauma. Soon a lot of those fatalities might be avoidable.
An international team of researchers led by epidemiologist Ian Roberts of the London School of Hygiene and Tropical Medicine recently tested an inexpensive drug called tranexamic acid (TXA) in a trial involving more than 20,000 trauma cases in 40 countries. Surgeons have long employed TXA to reduce bleeding during surgery, but it had never been carefully studied as a treatment for traumatic injuries. “The drug reduces bleeding by preventing the enzyme plasmin from breaking down fibrin, a protein crucial to clotting,” Roberts says. This past summer, he and his colleagues reported their first findings from the trial: Tranexamic acid reduced bleeding deaths among trauma patients by about 15 percent, a result that could translate to 100,000 lives saved per year worldwide.
Other experimental therapies could reduce the death rate even further. Surgeons at Massachusetts General Hospital were able to keep injured pigs alive after major bleeding by giving them a dose of valproic acid, which helps cells survive on less oxygen. The medication is ordinarily used to treat bipolar disorder and seizure. And anesthesiologist Volker Wenzel of Innsbruck Medical University in Austria has found that vasopressin, a natural hormone, helped keep pigs alive after they went into shock due to blood loss because it reduces circulation to the extremities while enhancing crucial flow to the heart and brain.
Wenzel is now leading a human trial of vasopressin. “We will assess whether it can stabilize hemorrhagic shock patients who do not respond to standard treatments,” he says.