The HAEM (Haemorrhage and Antifibrinolytics in Emergency Medicine) Project.

Acute severe haemorrhage is a major cause of mortality and morbidity in the UK and globally. Traumatic intracranial, gastrointestinal and postpartum haemorrhage, taken together, account for an enormous disease burden, causing many premature deaths, and in the case of intracranial bleeding, results in a large number of patients with long term disability. Recent results from the CRASH-2 trial show that tranexamic acid (TXA) significantly reduces mortality and morbidity in bleeding trauma patients, with no evidence of any increased risk of vascular occlusive events. TXA is not a new drug and is widely used in elective surgery to reduce bleeding. However, its repurposing for new indications has the potential to yield large public health benefits at low cost. If TXA also reduces mortality and morbidity in intracranial, gastrointestinal and postpartum bleeding this would be an important discovery. Systematic reviews of the existing evidence on TXA in these conditions and recent proof of concept studies conducted by the applicants provide firm grounds for optimism. The challenge is to conduct the clinical trials needed to resolve the uncertainty and confirm or refute such treatment effects. The applicants have established an extensive international network of emergency care trialists and have the experience and expertise needed to conduct these large trials.