Tranexamic acid

[Doczilla]

One of my classmates recently returned from Afghanistan and brought to my attention a drug they have been using over there in the ANA hospitals, which is also being carried by the Special Forces medics who may be further removed from trauma care.  It is a fibrinolysis inhibitor, but I don't think they really know how it works. You can download the study free from the Lancet, July 2010.

Is anyone out there using Tranexamic acid or Aminocaproic acid in their prehospital protocols, or considering it? The recent CRASH2 study provides some interesting data to consider. I'm only now finding out about it. Of course, I have no financial interest in it or the manufacturer.

BLUF: Randomized double blind controlled multicenter international trial of tranexamic acid (TXA) in 20,000 trauma patients from 274 patients in 40 countries.

Given as a single 1g dose, followed by an additional 1g over 8 hours.

Patients who "clearly needed" it were not randomized, nor were patients who had clear contraindications.

10% reduction in all-cause mortality

15% reduction in mortality from hemorrhage

No significant differences in blood units given, or number of surgeries

Trend toward benefit when given earlier after injury

Hospital-based protocol, not prehospital

No increase in vascular occlusive events such as CVA, MI, PE, or DVT.

Shelf stable at room temperature, $9 per dose

It's a hell of a lot cheaper than rFactor VIIa.

'zilla

[HERBIE1]

Interesting article. Thanks, doc. Amazing that it's so cheap- $9/dose? Cripes, hospitals charge that much for an aspirin. LOL

[Bieber]

Very interesting! I haven't heard about it around here, but I really like the looks of it. It seems like it could become one of those very few tools that could actually give EMS a chance to make a significant difference in trauma injuries and subsequent outcomes.

[DartmouthDave]

Hello,

That is very interesting.

The only time I have seen it used (very rare) was for high grade SAH in order to prevent the dome-like blood clot from break down. Or, when I was a student in a CVICU. Not sure why it was used there.

Cheers

[chbare]

Thanks for keeping us in the loop Doczilla!

Take care,

chbare.

[tniuqs]

Interesting article. Thanks, doc. Amazing that it's so cheap- $9/dose? Cripes, hospitals charge that much for an aspirin. LOL

From my readings this is spot on HERBIE1 the focus of the use of this med is in developing nations where access to surgical intervention is typically post mortum.

An interesting development never the less my hope it does not go the way of "pretend" volume expanders that have oxygen carrying capabilities, although that stuff I suspect is a bit more "pricey"

cheers

[Mark Trig Spencer]

Apparently we are getting in the UK soon http://www.paramedic.org.uk/2012/01/06/tranexamic_acid/

[spenac]

Interesting article. Thanks, doc. Amazing that it's so cheap- $9/dose? Cripes, hospitals charge that much for an aspirin. LOL

My guess is if it ever gets to the USA it will $90 a dose.

[hertzvanrental]

Yep we have it in my service in the UK along with a few others. Will be on every UK vehicle when the new guidelines eventually come out. In fact I used it the other night. Very cheap drug. It's been used for years in dental, knee and various other surgery. And PO for women with heavy periods. This is a huge step in prehospital care. It should be available to every paramedic around the world!

[systemet]

We're using this.