Tranexamic Acid and Trauma

Pusateri, Anthony E.; Weiskopf, Richard B.; Bebarta, Vikhyat S.; Butler, Frank K.; Cestero, Ramon F.; Chaudry, Irshad H.; Deal, Virgil; Dorlac, Warren C.; Gerhardt, Robert T.; Given, Michael B.; Hansen, Dan R.; Hoots, W. Keith; Klein, Harvey G.; Macdonald, Victor W.; Mattox, Kenneth L.; Michael, Rodney A.; Mogford, Jon E.; Montcalm-Smith, Elizabeth; Niemeyer, Debra M.; Prusaczyk, W. K.; Rappold, Joseph F.; Rassmussen, Todd; Rentas, Francisco J.; Ross, James D.; Thompson, Christopher C.; Tucker, Leo D.

doi:10.1097/shk.0b013e318280409a

Cited by 94 publications

(35 citation statements)

References 23 publications

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“…Despite this favorable outcome, several gaps in knowledge regarding the use of TXA in trauma were identified in a recent review by a United States Department of Defense Committee. Many issues raised are important in the pediatric population as well, including the need for: (1) a more clear cut identification of which patients might benefit from TXA, (2) development of animal models to establish efficacy and safety, and (3) further evaluation of the safety profile of TXA given the increased risk for thrombotic events and the lack of data regarding safety in children [93]. A 2008 systematic review analyzing the use of TXA in pediatric patients undergoing spine surgery revealed six studies.…”

Section: Treatment Options For Tic In Pediatric Traumamentioning

confidence: 99%

Coagulopathy After Severe Pediatric Trauma

Christiaans¹,

Duhachek-Stapelman

Russell

et al. 2014

Shock

109

106

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Trauma remains the leading cause of morbidity and mortality in the United States among children from the age 1 year to 21 years old. The most common cause of lethality in pediatric trauma is traumatic brain injury (TBI). Early coagulopathy has been commonly observed after severe trauma and is usually associated with severe hemorrhage and/or traumatic brain injury. In contrast to adult patients, massive bleeding is less common after pediatric trauma. The classical drivers of trauma-induced coagulopathy (TIC) include hypothermia, acidosis, hemodilution and consumption of coagulation factors secondary to local activation of the coagulation system following severe traumatic injury. Furthermore, there is also recent evidence for a distinct mechanism of TIC that involves the activation of the anticoagulant protein C pathway. Whether this new mechanism of posttraumatic coagulopathy plays a role in children is still unknown. The goal of this review is to summarize the current knowledge on the incidence and potential mechanisms of coagulopathy after pediatric trauma and the role of rapid diagnostic tests for early identification of coagulopathy. Finally, we discuss different options for treating coagulopathy after severe pediatric trauma.

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Section: Treatment Options For Tic In Pediatric Traumamentioning

confidence: 99%

Coagulopathy After Severe Pediatric Trauma

Christiaans¹,

Duhachek-Stapelman

Russell

et al. 2014

Shock

109

106

View full text Add to dashboard Cite

show abstract

“…6,7 The use of TXA in adult trauma is based on the results of a large, multicenter, randomized placebo controlled trial (The CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Hemorrhage 2), which demonstrated that early administration of TXA could improve survival in trauma patients. This was potentially explained by the adequate inhibition of fibrinolytic activity obtained after the administration of 2 g TXA over 8 hours.…”

Section: Introductionmentioning

confidence: 99%

Tranexamic Acid Use in United States Children's Hospitals

Nishijima

Monuteaux

Faraoni

et al. 2016

The Journal of Emergency Medicine

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Background The prevalence of tranexamic acid (TXA) use for trauma and other conditions in children is unknown. Objective The objective of this study was to describe the use of TXA in US children’s hospitals for children in general, and specifically for trauma. Methods We conducted a secondary analysis of a large, administrative database of 36 US children’s hospitals. We included children younger than 18 years who received TXA (based on pharmacy charge codes) from 2009 to 2013. Patients were grouped into the following diagnostic categories: trauma, congenital heart surgery, scoliosis surgery, craniosynostosis/craniofacial surgery, and other, based on ICD-9 principle procedure and diagnostic codes. TXA administration and dosage, in-hospital clinical variables, and diagnostic and procedure codes were documented. Results A total of 35,478 pediatric encounters with a TXA charge were included in the study cohort. The proportions of children who received TXA were similar across the years 2009–2013. Only 110 encounters (0.31%) were for traumatic conditions. Congenital heart surgery accounted for more than one-half of the encounters (22,863, 64%).. Overall the median estimated weight-based dose of TXA was 22.4 mg/kg (IQR 7.3 to 84.9 mg/kg). Conclusions We identified a wide frequency of use and range of doses of TXA for several diagnostic conditions in children. The use of TXA among injured children, however, appears to be rare despite its common use and efficacy among injured adults. Further work is needed to recommend appropriate indications for TXA, and provide dosage guidelines among children with a variety of conditions, including trauma.

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“…Thus, one may argue that tranexamic acid should have been administered to our patients anyhow. Although debated the Cochrane review from 2012 suggests that tranexamic acid safely reduces mortality in bleeding trauma patients without increasing the risk of adverse events [12, 13]. There is of course a need for further data before any general recommendation for the use of tranexamic acid as part of the management of suspected TRALI.…”

Section: Discussionmentioning

confidence: 99%

Suspected Transfusion Related Acute Lung Injury Improving following Administration of Tranexamic Acid: A Case Report

Ryniak

Harbut

Östlund

et al. 2014

Case Reports in Anesthesiology

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A 16-year-old woman with craniofacial injury developed severe acute respiratory failure under the primary reconstructive surgical procedure requiring several units of blood and plasma. A transfusion related acute lung injury (TRALI) was suspected and supportive treatment was initiated. Because of the severity of symptoms, acute extracorporeal membrane oxygenation (ECMO) was planned. During preparation for ECMO, a single intravenous dose, 1 g of tranexamic acid, was administered and a remarkable improvement was observed shortly thereafter. The patient was placed on ECMO for 16 hours. The further course was uncomplicated and the patient was discharged from ICU on the 6th day after admission fully and she recovered. A clinical improvement was observed in a timely fashion following the administration of tranexamic acid. The handling of a suspected TRALI and potential benefit from administration of tranexamic acid are discussed in this case report.

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Tranexamic Acid and Trauma

Cited by 94 publications

References 23 publications

Coagulopathy After Severe Pediatric Trauma

Coagulopathy After Severe Pediatric Trauma

Tranexamic Acid Use in United States Children's Hospitals

Suspected Transfusion Related Acute Lung Injury Improving following Administration of Tranexamic Acid: A Case Report

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