Prehospital Tranexamic Acid Administration During Aeromedical Transport After Injury

Boudreau, Ryan M.; Deshpande, Keshav K.; Day, Gregory; Hinckley, William R.; Harger, Nicole; Pritts, Timothy A.; Makley, Amy T.; Goodman, Michael D.

doi:10.1016/j.jss.2018.07.074

Cited by 17 publications

(19 citation statements)

References 21 publications

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“…Nevertheless, the low risk nature and cost of TXA treatment has led to its wider use among trauma hospitals and recognition within both European and American College of Surgeons major trauma and transfusion guidelines. 73,76 In Canadian hospitals with well-organized and resourced trauma services, TXA is unlikely to prevent death from exsanguination, but likely confers modest benefit on circumventing early hyperfibrinolysis effects seen with trauma-induced coagulopathy. This is a clinically relevant effect as hyperfibrinolysis is a key pathological mechanism and is an independent risk factor for mortality.…”

Section: Tranexamic Acid Use In Obstetricsmentioning

confidence: 99%

“…Néanmoins, la nature et le coût du traitement à base d'ATX n'entraînent que de faibles risques, ce qui a conduit à son utilisation étendue dans les hôpitaux de traumatologie et à sa reconnaissance dans les directives des collèges de chirurgiens européen et américain concernant les traumatismes majeurs et les transfusions. 73,76 Dans les hôpitaux canadiens où les services de traumatologie sont bien organisés et disposent des ressources nécessaires, il est peu probable que l'ATX prévienne un décès par exsanguination; cependant, ce traitement confère probablement des avantages modestes pour contourner les effets d'une hyperfibrinolyse précoce observés lors d'une coagulopathie induite par un traumatisme. Il s'agit là d'un effet pertinent d'un point de vue clinique car l'hyperfibrinolyse est un mécanisme pathologique clé et un facteur de risque indépendant de mortalité.…”

Section: • Lésions Contondantes Et Pénétrantes Inclusesunclassified

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Tranexamic acid: current use in obstetrics, major orthopedic, and trauma surgery

Wong

George

Hanley

et al. 2021

Can J Anesth/J Can Anesth

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In this Continuing Professional Development module, we review the practical pharmacology of tranexamic acid and its clinical use in trauma, obstetrics, and major orthopedic surgery. Principal findings Tranexamic acid is a synthetic drug that inhibits fibrinolysis. Multiple clinical trials in various clinical settings have shown that it can reduce blood loss, transfusion rates, and bleeding-associated mortality. In trauma and obstetrical bleeding, early tranexamic acid administration (\ three hours) may have greater clinical benefits. Overall, tranexamic acid use appears safe with no significant increase of thromboembolic or seizure events. Nevertheless, current evidence has limitations related to wide heterogeneity in dose, route, and timing of drug

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Section: Tranexamic Acid Use In Obstetricsmentioning

confidence: 99%

Section: • Lésions Contondantes Et Pénétrantes Inclusesunclassified

Tranexamic acid: current use in obstetrics, major orthopedic, and trauma surgery

Wong

George

Hanley

et al. 2021

Can J Anesth/J Can Anesth

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“…There is a growing body of literature on TXA and its effects following both systemic and topical administration. [64][65][66][67] Large trials evaluating TXA are ongoing, and identification of patients most likely to benefit from TXA remains elusive. The current evidence suggests that TXA is a useful adjunct in severe hemorrhage, irrespective of the underlying cause (Table 4).…”

Section: Discussionmentioning

confidence: 99%

The Role of Tranexamic Acid in the Management of an Acutely Hemorrhaging Patient

et al. 2020

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Background: Acute hemorrhage, both traumatic and nontraumatic, leads to significant morbidity and mortality, both in the United States and globally. Traditional treatment of acute hemorrhage is focused on hemostasis and blood product replacement. Tranexamic acid is an antifibrinolytic agent that may reduce acute hemorrhage through inhibition of plasminogen. Newer research suggests that coagulopathy, specifically fibrinolysis, may contribute significantly to the pathology of acute hemorrhage. Methods: We searched the PubMed database for relevant articles from 2000 to 2018 for the terms “tranexamic acid,” “TXA,” “antifibrinolytic,” “hyperfibrinolysis,” and “coagulopathy.” Our search was limited to studies published in the English language. Results: A total of 53 studies were included in this review. These articles suggest a potential role for tranexamic acid in the management of acute intracranial hemorrhage, epistaxis, hematuria, postpartum hemorrhage, gastrointestinal hemorrhage, and trauma-related hemorrhage. A theoretical risk of thrombotic events following tranexamic acid use exists, though large clinical trials suggest this risk remains exceedingly small. Conclusions: Recent studies suggest a mortality benefit with tranexamic acid following acute hemorrhage. First responders such as emergency medical technicians and emergency department clinicians should consider tranexamic acid as an adjunct therapy in the management of acute, severe traumatic and nontraumatic hemorrhage.

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“…TXA has been incorporated in the resuscitation protocols of severely bleeding patients in many trauma centers [110]. Prehospital TXA use may be selective for acutely injured patients with severe hemorrhagic shock or traumatic brain injury [111] and optimally guided by viscoelastic hemostatic assays [97].…”

Section: Tranexamic Acidmentioning

confidence: 99%

“…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].…”

Section: Safetymentioning

confidence: 99%

Hemostatic agents for prehospital hemorrhage control: a narrative review

Peng

2020

Military Med Res

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Hemorrhage is the leading cause of preventable death in combat trauma and the secondary cause of death in civilian trauma. A significant number of deaths due to hemorrhage occur before and in the first hour after hospital arrival. A literature search was performed through PubMed, Scopus, and Institute of Scientific Information databases for English language articles using terms relating to hemostatic agents, prehospital, battlefield or combat dressings, and prehospital hemostatic resuscitation, followed by cross-reference searching. Abstracts were screened to determine relevance and whether appropriate further review of the original articles was warranted. Based on these findings, this paper provides a review of a variety of hemostatic agents ranging from clinically approved products for human use to newly developed concepts with great potential for use in prehospital settings. These hemostatic agents can be administered either systemically or locally to stop bleeding through different mechanisms of action. Comparisons of current hemostatic products and further directions for prehospital hemorrhage control are also discussed.

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Prehospital Tranexamic Acid Administration During Aeromedical Transport After Injury

Cited by 17 publications

References 21 publications

Tranexamic acid: current use in obstetrics, major orthopedic, and trauma surgery

Tranexamic acid: current use in obstetrics, major orthopedic, and trauma surgery

The Role of Tranexamic Acid in the Management of an Acutely Hemorrhaging Patient

Hemostatic agents for prehospital hemorrhage control: a narrative review

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