Tranexamic Acid for Trauma Patients: A Critical Review of the Literature

Abstract

This inexpensive and safe drug should be incorporated into trauma clinical practice guidelines and treatment protocols. Further research on possible alternate mechanisms of action and dosing regimens for TXA should be undertaken. Concurrent to these endeavors, TXA should be adopted for use in bleeding trauma patients because it is the only drug with prospective clinical evidence to support this application.

Infrastructure and clinical practice for the detection and management of trauma-associated haemorrhage and coagulopathy

“…Accordingly, almost 80 % of all respondents declared to use this drug in bleeding trauma patients regularly and there is quest for its even more widespread use [30]. The remaining respondents declared to use aminocaproic acid as antifibrinolytic agent.…”

Procoagulant and fibrinolytic activity after polytrauma in rat

“…Inhibitors of plasmin generation, such as tranexamic acid, could prevent the rise in plasmin activity. Indeed, clinical trials have shown that tranexamic acid reduces bleeding in surgery and reduces mortality after trauma (1,5,8). However, tPA was not elevated throughout the 4 h and, therefore, cannot explain the continued rise in plasmin.…”

Postoperatives Management der Gerinnung

“…Unter anderem durch die CRASH-II-Studie [30] ist Tranexamsäure in den letzten Jahren als kostengünstiges, effektives und nebenwirkungsarmes Medikament in den Fokus geraten. Als Dosis hat sich bisher ein Bolus von 1-2 g gefolgt von 1-5 mg/kg/h etabliert [31]; die Dosierung ist jedoch ohne hinreichende Evidenz. Die Indikation zur postoperativen Gabe von Tranexamsäure bei Blutungskomplikationen ist bis heute nicht eindeutig bewiesen und kann deshalb zum jetzigen Zeitpunkt nur nach sorgfältiger Indikationsstellung empfohlen werden.…”