The research article I chose was to evaluated the proper use of Tranexamic acid in the trauma setting. The study was done in British Columbia at Royal Columbia Hospital in the emergency room. 100 patients were chosen out of 4328 in the British Columbia trauma registry. The researchers used a retrospective chart review study. No consents were needed for this study specifically. The correct use of TXA has been clinically shown to decrease mortality in trauma patients and outcomes associated with the administration of the medication. It is important to understand the proper administration, expected outcomes and usages of medications especially in a trauma setting.
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There are definitely some information and studies that reflect the efficacy for the use of tranexamic acid in trauma patients showing it reduces the mortality and need for mass transfusion protocols. There was concern, in the study I found, for the increased finding of venous thrombus in the group that received the TXA (El Menyar, A., et al, 2020). Due to it’s nature and mechanism, the concern for blood clots in patients that received that treatment would need further investigations and possible protocols to monitor and prevent DVTs in that population.
El-Menyar, A., Sathian, B., Wahlen, B. M., Abdelrahman, H.,
Peralta, R., Al-Thani, H., & Rizoli, S. (2020). Prehospital
administration of tranexamic acid in trauma patients: A 1:1
matched comparative study from a level 1 trauma center. The
American Journal of Emergency Medicine, 38(2), 266-271.
doi:http://dx.doi.org.butlerlib.butlercc.edu/10.1016/j.ajem.
2019.04.051
I had never heard of tranexamic acid, which really surprised me since I had worked ED for the majority of my career, just not specifically trauma. The article I looked at was discussing that utilizing tranexamic acid significantly reduced the risk of death due to bleeding when used early (< 1hr from time of injury) in the study of 20,211 trauma patients. The study also was against prophylactic transfusions due to less side-effects of transfusion related complications. They did recommend the use of fresh frozen plasma. They also recommended early administration of plasma, platelets, and red blood cells in a 1:1:1 ratio compared to a 1:1:2 ratio did not results in significant differences in mortality at 24hrs or even 30 days. More 1:1:1 patient achieved hemostasis.
Jerrold Levy, MD, FAHA, FCCM; Dietmar Fries, MD; Marc Maegele, MD. Through the Looking Glass: Factors Predicting Outcomes in Trauma Patients. Medscape. 06/26/2020
As of 2019, my facility has been administering Tranexamic Acid as adjunctive therapy for the treatment of postpartum hemorrhage, when initial medical therapy fails to achieve hemostasis. Studies evaluating the efficiency of tranexamic acid for the treatment of postpartum hemorrhage have demonstrated decreased mortality from obstetric hemorrhage, with no increased risk of adverse effects,
including thromboembolic events. The 2012 WHO guidelines recommended tranexamic acid for PPH treatment when uterotonics fail to control bleeding or trauma related bleeds. Similarly, the current American College of Obstetricians and Gynecologists (ACOG) guideline on PPH recommends that tranexamic acid should be considered when initial medical therapy, including massage, surgical repair and the use of uterotonics, fail to achieve hemostasis.
Fahrenholtz CG, Bonanno LS, Martin JB. Tranexamic acid as adjuvant treatment for postpartum hemorrhage: a systematic review protocol. JBI Database System Rev Implement Rep. 2019;17(8):1565-1572. doi:10.11124/JBISRIR-2017-003978
That is a very interesting article. While doing research it was interesting to see how many different ways TXA can be utilized. We use it frequently in nosebleeds. There are little to no side effects with it if used properly. I will have to do more research on PPH and treatment!
Good subject and very interesting! As a previous trauma nurse we did use Tranexamic acid more so than not. The only thing we always worried about was blood clot development. I wonder what the satistics were for people who develop a blood clot post the use of Tranexamic acid. How do they go about counter acting that at the same time as treating the patient? Upon researching, it looks like TXA does not increase the risk of a DVT. Below is the article that I found quiet interesting. Good post! I really learned a lot from this journal.
https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-016-0201-0
DS. Kauvar, R., RL. Gruen, G., S. Okamoto, U., T. Kobayashi, J., DA. Fergusson, P., W. Dietrich, M., . . . A. Wafaisade, R. (1970, January 01). Tranexamic acid and trauma-induced coagulopathy. Retrieved July 12, 2020, from https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-016-0201-0
Being a PACU nurse for the most part I looked at an article on the use in surgery, specifically orthopedics since this these surgeries historically have a higher blood loss. In this study the main concern was in the population at higher risk for thromboembolitic complications. Though it seems to be that the potential to decrease blood loss, which is also a problem for this population, may outweigh the risks of the drug. It seems cost wise and efficacy of the drug are well documented.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416949/
I know that we have talked about this at my place of work but as a critical access hospital we stabilize and transport to trauma center. Of course it is on hand for our OB patients and in the OR. I think it would be great to be a standard though. My concern would be blood clot formation just like TPA we worry about bleeding out. I did find that there is a time frame for this treatment of 3 hour window after incident, kind of the same as our TPA window.
Chauncey, J., & Wieters, J. (2019, December 16). Tranexamic acid – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK532909/