Tranexamic Acid: Implementing a Clinical Guideline for its use in a Moderate Resource Setting

Abstract

Background: Guyana, located on the northern South American Mainland is a moderate resource, developing country with high rates of traumatic hemorrhage. There is a shortage of blood products available for use in the emergency department of Georgetown Public Hospital, the main tertiary public hospital. Tranexamic acid (TXA) is an antifibrinolytic that inhibits both plasminogen activation and plasmin activity, thus preventing clot breakdown. CRASH-2, a large randomized, multicenter double blind, placebo-controlled clinical trial, that showed that TXA reduces mortality and blood product use in acute trauma in a moderate resource setting. Currently TXA is not available for use in the public health system in Guyana. Methods: A literature review was conducted using Google Scholar and PubMed, and by analyzing review articles from the Cochrane Database, European Guidelines, NICE Guidelines. Sources were analyzed to determine pharmacology, feasibility and utility of TXA in moderate resource emergency medicine settings such as Guyana. Steps were taken to bring TXA for use in the public health system in Guyana. Results: Meetings with stakeholders. Cost analysis. A protocol for initial utilization. Plan for data collection and future expansion. Conclusions: Tranexamic acid is a safe and inexpensive drug that should be incorporated into trauma clinical guidelines for the resuscitation of the bleeding patient at Georgetown Public Hospital. Implementing a clinical guideline for the use of tranexamic acid in trauma at GPHC will improve mortality due to bleeding and reduce the use of blood products.