To the Editor Endogenous plasmin produced during trauma and surgery reduces clot stability and worsens bleeding. Plasmin production can be inhibited with tranexamic acid, a competitive antagonist of the lysine binding sites on plasminogen. Although caution is urged in patients at high risk of arterial occlusive events, due to the possibility that tranexamic acid might precipitate myocardial infarction, results from clinical trials show that tranexamic acid decreases rather than increases the risk of myocardial infarction.

The clinical randomisation of antifibrinolytic in significant haemorrhage 2 (CRASH-2) trial was a multicentre randomised controlled trial of early (within 8 h of injury) administration of tranexamic acid (1 g intravenous, loading dose followed by 1 g infusion over 8 h) or placebo in 20 211 patients with traumatic bleeding. Tranexamic acid …