Royal London Hospital research to help trauma victims

A new approach to treatment for severe bleeding trauma victims, has shown positive results.

Tranexamic acid (TXA), is usually given by intravenous injection (IV) but securing an intravenous line can take time and the drug has to be injected slowly. This new research, led by the London School of Hygiene & Tropical Medicine and carried out at The Royal London Hospital Major Trauma Centre, shows that TXA can also be given by intramuscular injection. They found that the drug is rapidly absorbed from muscles and there were no local adverse effects.    

TXA is a drug that prevents severe bleeding after injury by stopping blood clot breakdown, and is most effective when given soon after injury. Every 15 minutes treatment delay reduces its lifesaving potential by 10%. However, currently only 3% of UK trauma victims get TXA within an hour of injury.  

Ross Davenport, Clinical Lead for Trauma Surgery at The Royal London Hospital and Senior Lecturer at Queen Mary University of London, said: “This is an important study that looked at an alternative method to administer a medication to treat bleeding in critically injured patients. Tranexamic is a drug that has been shown in large clinical trials to save lives in bleeding trauma patients and importantly that the sooner it is given the greater its effects.”  

“By trialling a new method of drug administration via the intramuscular injection as opposed to an intravenous route it means that potentially more patients can receive it, soon after injury before they reach hospital, with the potential that even more lives can be saved.” 

Dr Ian Roberts from LSHTM who led the study said: “An urgent injection of TXA is life-saving after serious injury but patients are not being treated fast enough. A rapid intramuscular injection given by first responders or paramedics could mean the difference between life and death. Intramuscular TXA is like a vaccine against trauma death.”  

In this study, 30 bleeding trauma patients at the Royal London Hospital and St George’s Hospital were given the first dose of TXA intravenously, as per guidelines, but the second dose by IM injection. The team then collected blood samples, monitored injection sites and measured TXA concentrations. 

The team found that intramuscular TXA is well tolerated with only mild and transient injection site reactions, with some redness and transient swelling. Importantly, TXA was rapidly absorbed from muscle reaching the levels needed to save lives within 15 minutes even in the sickest patients.