The Use of Tranexamic Acid (TXA) for the Management of Hemorrhage in Trauma Patients in the Prehospital Environment: Literature Review and Descriptive Analysis of Principal Themes

Abstract

Tranexamic acid (TXA) is an antifibrinolytic agent used to prevent traumatic exsanguination. It was first introduced to clinical practice for the management of patients with bleeding disorders, especially adapted to reduce bleeding in hemophiliacs undergoing oral surgical interventions. TXA exerts its action on the coagulation process by competitively inhibiting plasminogen activation, thereby reducing conversion of plasminogen into plasmin. This ultimately prevents fibrinolysis and reduces hemorrhage. Thus, TXA may be well suited for the management of traumatic hemorrhage in the prehospital setting. Despite multiplicity of studies on the use of TXA in clinical practice, there is no consensus regarding the use of TXA for the management of hemorrhage in trauma patients in the prehospital environment. Thus, a review on this topic was warranted. An extensive literature search yielded 14 full journal articles which met the inclusion criteria. These articles were thoroughly analyzed and the following themes were identified: “dose of TXA administration,” “route of TXA administration,” “optimal window of TXA administration,” “safety of TXA use,” “clinical effectiveness of TXA application,” and the “feasibility of TXA use in the prehospital setting.” Overall, to achieve the best possible outcomes, the literature supports the use of a loading dose of 1 g of TXA, followed by 1 g infusion over 8 h, given by intravenous administration within a 3-h window period of traumatic injury. TXA is very effective and safe to use in the prehospital setting, and its use is clinically and economically feasible.

The efficacy and safety of tranexamic acid in high tibial osteotomy: a systematic review and meta-analysis

“…Due to its anti-fibrinolytic property, it is commonly used in total hip and knee arthroplasty [ 10 – 14 ]. TXA is a synthetic lysine analog that competitively blocks the lysine binding site on fibrinolysin and plasminogen, thus inhibiting the activation of plasminogen to plasmin, and also promotes clot formation by regulating the platelet dispersions [ 15 , 16 ].…”

Human Plasminogen Exacerbates Clostridioides difficile Enteric Disease and Alters the Spore Surface

“…The G05 antibody has a short half-life (data not shown) and would need to be engineered for optimal luminal delivery and minimization of systemic effects; further optimization and rigorous clinical testing must therefore occur before this type of treatment can be used. Nevertheless, this approach of targeting the plasminogen / plasmin system is supported by the existing short-term clinical (extraintestinal) use of tranexamic acid, an FDA approved plasminogen activation inhibitor, which is currently used to reduce haemorrhaging in severe trauma and blood disorder patients 42 . Since several gastrointestinal pathogens mediate disease through toxigenic effectors which compromise tissue integrity, and many other gastrointestinal disorders result in similar leaky gut effects, our results have broader implications for our understanding of the mechanisms underlying enteric diseases and further raise the possibility that inhibition of human plasmin(ogen) may be of broad therapeutic utility.…”

Management of Patients with Gastrointestinal Hemorrhage While Receiving Warfarin: Vitamin K, Prothrombin Complex Concentrates and Others

“…In addition, a number of welldesigned multicentric controlled studies such as CRASH have pointed out that tranexamic acid can be used with considerable success in traumatic hemorrhages including most fatal ones, i.e., intracranial hemorrhages and shocky states without a defined source of bleeding. In these grave circumstances, tranexamic acid is recommended to be administered within first 3 hours following trauma [35]. However, tranexamic acid has not proven to decrease blood loss or improve clinical outcomes in patients presenting with GI hemorrhage to date [36].…”