I first heard about Tranexamic Acid in 2013 at the annual Austin Trauma and Critical Care Conference. Dr. Matt Davis, the System Director of Trauma at Baylor Scott & White-Central, spoke on the topic.
See the video here: VIIa, TXA and PCC, Matt Davis, MD FACS
Like many topics at the conference I was interested as it pertained to the second love of my life, Trauma. I didn’t fully appreciate then that I would see this picture of a medic in an ambulance on Facebook within 3 short years:
And who posted it?
A student who had come through my classroom the same years I heard about TXA at the conference. He didn’t hear about TXA in my trauma class because education is incredibly slow. Educators hear a lot about devices and medications in clinical trials. We work to filter the information to spare them overload.
Plus, I didn’t remember how to say it!
So how do you say it? Most people don’t. Instead they say “TXA.” And I’m good with that because I’ve typed it at least 20 times today and still have to look at my notes for spelling.
How do you say it?
is how I say it.
So now that we’ve got that covered, what is this stuff?
TXA inhibits fibrinolysis. That’s a bit of a double negative. It slows down the break down of clots that may be forming.
When is it indicated?
It is indicated when a trauma patient is suspect for bleeding or risk for bleeding and
it’s been < 3 hours since the injury
HR is > 110
SBP < 100
Two major studies showed decreased mortality in these patients when TXA was administered.
CRASH is the one I’m most familiar with and it was a BIG study.
Over 20,000 patients in 40 countries who had trauma were either given TXA or a placebo in a randomized trial.
The outcome was that the group who got TXA saw a 1.5% decrease in mortality.
Sounds small right?
20,000 x 0.015 = 300 fewer deaths
Sounds bigger right?
If you’d like to know more, here is a link to a JEMS article that does a really nice job covering the study as it pertains to EMS in more detail.
It seems time is an issue here. Those who received TXA earlier did better. I suppose this is how that vial wiggled it’s way into the ambulance above. It’s also relatively inexpensive and safe.
Here’s the slide I made so students (and you) can hear about it now:
(Better late than never)
If you want to know more about TXA directly from one of the lead investigators in the CRASH study, listen here:
One of my earliest questions was, “Could this stuff stop fibrinolysis to the point of causing harm?”
Scott Weingart of EM Crit says, “TXA is not associated with an increased risk of vascular occlusive events.”
TXA is not a wonder-clotting drug.
Rather it is better to say that TXA tilts the balance toward clotting.
Are you a medic using TXA, I’d love to hear from you. When did you give it? How’d it go?