Holly Hollenbaugh-Fogle RN, BSN, CCRN
Children’s Hospital of Pittsburgh of UPMC
The Use of Tranexamic Acid in
Traumatic Bleeding
Conclusion
4
Results
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Background
1 In spite of major improvements in trauma care, traumatic
hemorrhage continues to lead as the main cause of preventable
death after injury. For this reason there has been a surge of research
in blood component therapy and trauma resuscitation. We are left to
question our use of crystalloid resuscitation and blood product ratios.
In a continued quest to improve outcome tranexamic acid is now
under investigation as a cheap and safe means of decreasing
hemorrhage in early injury.
Tranexamic acid is an anti-fibrinolytic that blocks the action of
plasminogen, an enzyme that dissolves clots. Tranexamic acid has
been used for decades to minimize blood loss in surgery, especially
cardiac and orthopedic surgery.
Tranexamic Acid will be referred to as TXA at times in this poster.
Caption for this graphic goes here.
2
Methods
Both the British and American military have added TXA to
their transfusion protocols.
The CRASH-2 randomized controlled trial sought to assess the
effect that early administration of tranexamic acid had on death,
vascular occlusive events and blood transfusion on patients with
traumatic hemorrhage. It involved 274 hospitals, 40 countries
and 20,211 patients. 10,096 patients were allocated to
tranexamic acid and 10,115 were to placebo. The CRASH-2
study showed that administration of tranexamic acid to adult
trauma patients with, or at risk of , significant hemorrhage,
within eight hours of injury, significantly reduces all-cause
mortality with no apparent increase in vascular occlusive
events.(1) Early treatment defined as within 1 hour of injury
demonstrated a 5.3% risk of death in the TXA group vs. 7.7% in
the placebo group. When treatment was given within 1-3 hours
of injury the risk of death for the TXA group was 4.8% vs. 6.1%
for the placebo group.
The MATTERs retrospective study of 900 NATO casualties
showed there was no difference in mortality between the
tranexamic acid group and the placebo group at 24 hours, even
though the tranexamic acid group was more severely injured. At
28 days the mortality for the tranexamic acid group was
substantially lower and at the 28-day mark, mortality for the TXA
group was half of that of the placebo group.(2)
Because of the CRASH-2 trial the World Health
Organization has added TXA to their list of essential drugs.
In the United States, the University of Texas Health Science
Center in Houston and the Mayo Clinic in Rochester, Minn.
Have added TXA to the drugs to be administered on the
medical helicopters and the ED departments.
TXA is best administered within three hours of injury, so in
developed countries the best role for TXA may be in a
prehospital setting.
Tranexamic acid is safe, effective and cheap with few
contraindications or adverse reactions.
Tranexamic acid has the potential to be an exciting new
“tool” in our kit to treat traumatic bleeding and warrants our
serious attention as we try to find answers to the best way
to volume resuscitate our trauma patients.
5
References
Insert your references here
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This poster is informational and is meant to educate trauma care
providers on tranexamic acid. The method used was literature
search only. A recent discussion of tranexamic acid in our institution
has lead to some interesting debates on its use in a prehospital
setting.
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•One: Review of CRASH-2 trial
•Two: Review of MATTERs study
•Three: Review of the literature reaction to these studies
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1.The CRASH-2 Collaborators. Effects of tranexamic acid on death, vascular
occlusive events, and blood transfusion in trauma patients with significant
hemorrhage(CRASH-2): a randomised, placebo-controlled trial. Lancet 2010;
376:23-32..
2.Morrison JJ, Dubose JJ,Rasmussen TE,Midwinter, MJ. Military Application of
Tranexamic Acid in Trauma Emergency Resuscitation(MATTERs) Study. Arch
Surg 2012; 147:113-9..