Tranexamic Acid Use in Prehospital Uncontrolled Hemorrhage

Abstract

The use of tranexamic acid (TXA) in the treatment of trauma patients was relatively unexplored until the landmark Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage-2 (CRASH-2) trial in 2010 demonstrated a reduction in mortality with the use of TXA. Although this trial was a randomized, double-blinded, placebo-controlled study incorporating > 20,000 patients, numerous limitations and weaknesses have been described. As a result, additional studies have followed, delineating the potential risks and benefits of TXA administration. A systematic review of the literature to date reveals a mortality benefit of early (ideally < 1 1hour and no later than 3 hours after injury) TXA administration in the treatment of severely injured trauma patients (systolic blood pressure < 90 mm Hg, heart rate > 110). Combined with abundant literature showing a reduction in bleeding in elective surgery, the most significant benefit may be administration of TXA before the patient goes into shock. Those trials that failed to show a mortality benefit of TXA in the treatment of hemorrhagic shock acknowledged that most patients received blood products before TXA administration, thus confounding the results. Although the use of prehospital TXA in the severely injured trauma patient will become more clear with the trauma studies currently underway, the current literature supports the use of prehospital TXA in this high-risk population. We recommend considering a 1 g TXA bolus en route to definitive care in high-risk patients and withholding subsequent doses until hyperfibrinolysis is confirmed by thromboelastography.

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

“…Meanwhile, goal directed therapy represents the current standard (128,129). Along with these changes, the use of additional medication such as Tranexamic acid (TXA) have been shown to be important in acute hemorrhage conditions; some suggest an enhancement of clot formation (130), a group of patients presenting with depletion of fibrinolysis treated with TXA to develop a significantly improved fibrin clot strength (117,(131)(132)(133)(134)(135).…”

Multiple trauma management in mountain environments - a scoping review

“…Antifibrinolytics Coagulopathy increases mortality in severe exsanguination. Haemorrhagic death [79][80][81][82][83][84] and multi-organ failure with severe shock [85] decrease with administration of tranexamic acid TXA) within 3 h after trauma, without increasing the risk of thrombosis [79]. The dose is 1 g intravenously (IV) over 10 min, followed by 1 g IVover 8 h [61].…”

Hemostatic agents for prehospital hemorrhage control: a narrative review

“…Prehospital administration of TXA during aeromedical transport was found to increase the risk of venous thromboembolic events compared with administration at the emergency department [111]. It has been recommended that a one-gram prehospital TXA bolus be administered in high-risk patients followed by subsequent doses guided by thromboelastography [42]. Additionally, a pharmacovigilance study concluded that there was no increased risk of thromboembolic events in FC-treated patients [219].…”