Tranexamic acid – A narrative review for the emergency medicine clinician

Wang, Kellie; Santiago, Ruben D.

doi:10.1016/j.ajem.2022.03.027

Cited by 19 publications

(8 citation statements)

References 138 publications

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“…The studies reported below identify a subgroup of trauma patients who are expected to benefit from timely and proper treatment with TXA. In 2011, the results of the CRASH-2 study were published reporting reduced all-cause mortality in adult trauma patients treated with tranexamic acid [ 71 ]. Thereafter, this study demonstrated that TXA, when administered more than 3 h after the acute event, leads to an increased risk of venous thromboembolism [ 71 , 72 ] and risk of hemorrhage-related death [ 73 ].…”

Section: Discussionmentioning

confidence: 99%

“…In 2011, the results of the CRASH-2 study were published reporting reduced all-cause mortality in adult trauma patients treated with tranexamic acid [ 71 ]. Thereafter, this study demonstrated that TXA, when administered more than 3 h after the acute event, leads to an increased risk of venous thromboembolism [ 71 , 72 ] and risk of hemorrhage-related death [ 73 ]. International guidelines support the hypothesis that TXA should be administered early, within 3 h after a traumatic event [ 74 ].…”

Section: Discussionmentioning

confidence: 99%

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Severe Trauma-Induced Coagulopathy: Molecular Mechanisms Underlying Critical Illness

Zanza

Romenskaya

Racca

et al. 2023

IJMS

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Trauma remains one of the leading causes of death in adults despite the implementation of preventive measures and innovations in trauma systems. The etiology of coagulopathy in trauma patients is multifactorial and related to the kind of injury and nature of resuscitation. Trauma-induced coagulopathy (TIC) is a biochemical response involving dysregulated coagulation, altered fibrinolysis, systemic endothelial dysfunction, platelet dysfunction, and inflammatory responses due to trauma. The aim of this review is to report the pathophysiology, early diagnosis and treatment of TIC. A literature search was performed using different databases to identify relevant studies in indexed scientific journals. We reviewed the main pathophysiological mechanisms involved in the early development of TIC. Diagnostic methods have also been reported which allow early targeted therapy with pharmaceutical hemostatic agents such as TEG-based goal-directed resuscitation and fibrinolysis management. TIC is a result of a complex interaction between different pathophysiological processes. New evidence in the field of trauma immunology can, in part, help explain the intricacy of the processes that occur after trauma. However, although our knowledge of TIC has grown, improving outcomes for trauma patients, many questions still need to be answered by ongoing studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Severe Trauma-Induced Coagulopathy: Molecular Mechanisms Underlying Critical Illness

Zanza

Romenskaya

Racca

et al. 2023

IJMS

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“…As a result, the World Health Organization (WHO) published an updated recommendation on the use of TXA for PPH treatment 4 . Since then, several studies have been performed to evaluate the safety and effectiveness (including cost‐effectiveness) of TXA for the prevention and treatment of PPH, which may occur after vaginal as well as cesarean deliveries 5–14 …”

Section: Introductionmentioning

confidence: 99%

“…then, several studies have been performed to evaluate the safety and effectiveness (including cost-effectiveness) of TXA for the prevention and treatment of PPH, which may occur after vaginal as well as cesarean deliveries. [5][6][7][8][9][10][11][12][13][14] Currently, there is no published study on the awareness of health care professionals regarding the use of TXA for the prevention and management of PPH in Nigeria. Therefore, this study aimed to determine the knowledge and practice of health care providers in Enugu metropolis on the use of TXA for the management of PPH and the barriers to effective adoption and implementation of the new recommendation.…”

mentioning

confidence: 99%

Awareness and use of tranexamic acid in the management of postpartum hemorrhage among health care professionals in Enugu, Nigeria

Onwujekwe,

Mosanya,

Ekwuazi

et al. 2023

Intl J Gynecology & Obste

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ObjectivesThis study was conducted to determine the knowledge, practice, and barriers regarding the use of tranexamic acid (TXA) for the prevention and treatment of postpartum hemorrhage (PPH) among health care providers in Enugu, Nigeria.MethodsA cross‐sectional study was conducted among health professionals (doctors, pharmacists, and nurses) in two Nigerian tertiary teaching hospitals (one federal and one state). A total of 220 questionnaires were distributed and 207 were returned (response rate: 94%) and analyzed using SPSS for inferential statistics with a level of significance of P < 0.05.ResultsOnly 23.7% of the respondents had good knowledge of TXA use in PPH (P < 0.001), and awareness of the recent World Health Organization (WHO) recommendation on the use of TXA for PPH was low (19.8%, P < 0.001). The majority of the respondents had neither prescribed nor dispensed TXA (30%, P < 0.001). Very few respondents used TXA for all cases of PPH (16.4%, P < 0.001). Barriers against its use include nonawareness of the latest WHO recommendation, preference for other uterotonics, and cost of the drug.ConclusionsThere was poor knowledge of TXA, poor awareness of its recommendation, and low use for PPH among different cadres of health care providers.

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“…Tranexamic acid also has an immediate effect on clot formation by increasing the activity of coagulation factors including factor IX and factor X. This increases clot stability and decreases bleeding [2]. Tranexamic acid also has a second method of action, which is to prevent the activation of clotting factors by binding to the clotting enzyme, factor Xa.…”

mentioning

confidence: 99%