By Jane Elliott
Health reporter, BBC News
It is hoped the tablets will cut blood loss
Three million people die from trauma globally each year - many bleed to death.
Now scientists are hopeful that a treatment currently in use in routine surgery could hold the answer to preventing catastrophic blood loss - at a cost of less than £5 per patient.
Professor Ian Roberts, of the London School of Hygiene and Tropical Medicine - who is leading the two year study into the affects of tranexamic acid - said it would be the largest ever trauma trial recruiting 20,000 patients from 47 countries.
He said the drug, although widely in use, had never been tried in trauma despite its proven record in reducing blood loss.
Hoping for answers
"This is a treatment that has been used for many years.
"It started off being used for patients who had major cardiac surgery who had large blood loss. They gave the drug to try and reduce this loss and found it was effective. It reduces clot break down."
This led Professor Roberts to question whether it could work to stop bleeding in trauma patients.
WHY BLOOD LOSS KILLS
Blood carries oxygen to the tissues and oxygen is essential for life
Blood loss after injury can lead to a fall in blood pressure and vital organs cease to function unless they get a constant supply of oxygenated blood
Excessive blood loss can worsen neurological outcome after head injury and can lead to
multi-organ failure, including renal failure
"It has never been tried in trauma where a patient can actually bleed to death.
"I think it is quite exciting really because if it has the same effect as it does in surgical patients then it could save thousands of patients a year."
He said interest is already high, especially from the Army who are keen to see if the treatment can be used to save lives on the battlefield.
Professor Roberts said: "This is something that could be used in the battlefield situation to reduce combat casualties and it could be used for civilian casualties."
Less than £5 a dose
He said it could also have a big impact on reducing deaths from road traffic accidents and violence - potentially preventing tens of thousands of deaths globally each year.
The need for transfusions may be reduced
"Many millions of patients die from trauma worldwide. And of those patients who survive to reach hospital, many die of blood loss."
The drug is patented and would cost less than £5 a dose, he added.
Professor Roberts recently headed up the CRASH trial which established that corticosteroids, a routine treatment for patients with head injuries, do not improve survival rates and may do more harm than good.
This latest trial, CRASH-2, funded by the Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), will examine the clinical and cost-effectiveness of tranexamic acid for treating trauma patients.
Patients will be given either tranexamic acid or a dummy drug within eight hours of injury, to see whether the number of deaths in hospital, or the need for blood transfusions, is reduced.
Professor Roberts expects good results from this study.
Compiling global data
So far 6,000 patients have been recruited to the trial. The research
team hopes to have recruited 20,000 patients to the trial by 2010.
Professor Roberts said: "It is important that large numbers of patients are involved in the trial, so that even moderate effects can be measured.
HOW TRANEXAMIC COULD HELP
Tranexamic acid helps clotting by reducing clot breakdown
Blood clotting is the body's own way of reducing blood loss after injury
How well the blood clots depends on the balance between clot formation and clot breakdown
"Even a small increase in survival would be significant in terms of the number of lives saved."
Brigitte Chaudhry, the founder of RoadPeace and the president of the European Federation of the Victims of Road Traffic Injuries, agreed.
"With more than 3,500 people daily losing their lives on the world's roads, we who represent road crash victims consider this trial to be of immense importance.
"Road deaths shatter the lives of families and communities and this very serious issue deserves research that has the potential to save countless lives and prevent so much devastation and suffering."