Tranexamic acid: an interview with Prof Ian Roberts

Interview conducted by April Cashin-Garbutt, MA (Editor)Sep 19 2012

Interview conducted by April Cashin-Garbutt, BA Hons (Cantab) on 14^th September 2012

Please could you give a brief introduction to tranexamic acid?

Tranexamic acid is a medicine that reduces blood clot breakdown. In this way it helps in patients with bleeding.

What can tranexamic acid be used to treat?

Tranexamic acid has been licensed for use for many years to treat mild bleeding conditions, like the bleeding you experience when you’ve had your teeth taken out, or heavy periods in women.

More recently, we have tested whether it works in more severe bleeding. For example, trauma patients often bleed to death. We did a big clinical trial and found that tranexamic acid can be used for severe bleeding.

When did tranexamic acid become available for use by doctors?

Tranexamic acid has been around for about 50 years for use in mild bleeding.

In 2010, we published the first paper from the big clinical trial, the CRASH2 trial, which showed that it saves lives in bleeding trauma patients. So it was available for use by doctors since then.

Why is it difficult for health care professionals to keep track of new drugs that come on to the market?

I think it is because there is so much information out there to read. Obviously big clinical trials are more important than other kinds of research, but doctors can be overwhelmed with information.

There are hundreds of medical journals each week publishing research. It is not straight forward for doctors to find out what’s relevant to them.

Also, people have a certain attention span, so it helps if the information is packaged in a way that is enjoyable.

How have you tried to increase health care professional’s knowledge of tranexamic acid?

We’ve done all the things that we were expected to do such as publish in medical journals. But what we were determined to do, because the treatment can obviously save lives, is to go a little bit further than that. So we made films, songs, cartoons and little animations. We’ve tried to be more innovative than traditional methods.

How many health care professionals were using tranexamic acid previously?

It is difficult to say as people don’t regularly do surveys, but we know that since the trial was published its use has increased dramatically. There is still some way to go, however.

What impact do you think the recent comic will have?

I’m not sure really. We haven’t distributed it yet, it was just launched on our website this week. But we will be printing it and sending it to all emergency departments in the UK and many overseas.

I hope that because it is a little bit different it will get people talking about tranexamic acid and trauma. I think Oscar Wilde once said there’s only one thing worse than being talked about and that is not being talked about. That is what we want: we want to cause interest in tranexamic acid, so that people want to find out more.

Are there plans to create comics for other new drugs?

I haven’t got any plans to do that. In a way, in order to get your message across you’ve got to make it stand out from the other messages. So the fact that other people don’t make comics is a good reason to make a comic; but if everyone made comics then you’d have to make something else.

Are there any plans to use other creative methods to educate health care professionals on latest medical developments?

Definitely, but we are still thinking about those. We are interested in film and song. Basically, my reading on the aspects of things that we remember is that humans are wired for emotional narrative. So stories where there are emotions in them are memorable.

We tell each other stories all the time in our lives. A short narrative, especially an emotionally charged narrative is very memorable. But if I said, “the relative risk of death with tranexamic acid is 0.72 with a confidence interval of…” it is completely unmemorable.

Science is good at getting at the truth, but once you’ve found the truth, the methods that you use with science aren’t very good at getting the truth remembered. What we’re trying to do is get science to find the truth and use art to remember the truth.

How do you think the future of tranexamic acid will progress?

We’ve got other clinical trials of tranexamic acid in other bad bleeding conditions like stomach bleeding, post-partum hemorrhage, which is the bleeding that women get after childbirth. Lots of women die from post-partum hemorrhage around the world – around 100,000 a year.

We’ll get the results of those trials and then we’ll try to think of ways to disseminate those results that are appropriate to the topic.

Where can readers find more information?

They can view the comic here: https://www.lshtm.ac.uk/

They can find out more information on the London School of Hygiene and Tropical Medicine here: http://www.lshtm.ac.uk/

About Prof Ian Roberts

Ian Roberts is Professor of Epidemiology & Public Heath at the London School of Hygiene & Tropical Medicine. His main research interests are the prevention and treatment of trauma and the links between energy and health.

He trained as a paediatrician and then in epidemiology at the University of Auckland, New Zealand and at McGill University, Canada. He established and is co-ordinating editor of the Cochrane Injuries Group, an international network of individuals that prepares and maintains systematic reviews of the effectiveness of interventions in the prevention, treatment and rehabilitation of injury.

He is principal investigator of the CRASH trials, large international randomised controlled trials that seek better ways to treat seriously injured trauma patients. The MRC CRASH trial, which included 10,000 patients with head injury from around the world, showed that corticosteroids, which were widely used in the management of head injury, did not improve patient outcome after head injury but increased the risk of death. The CRASH-2 trial has shown that tranexamic acid, an inexpensive and widely practicable treatment, safely reduces mortality in bleeding trauma patients.

He is the author with Phil Edwards of The Energy Glut: the politics of fatness in an overheating world.