TXA – Tranexamic Acid

TXA a bleeding wonder drug!

Multi-Centre RCT of the use of TXA in trauma
Inclusion – Adult trauma patients with ≥1 of
- Suspicion of significant haemorrhage
- HR ≥110bpm
- sBP ≤90mmHg
Treatment – 1g TXA IV over 10min then a second 1g TXA IV over 8hrs
Outcome – Significant reduction in Death, bleeding with NO increase in clots(thrombotic disease)
- Most benefit seen if given early (<3hr – NNT 53)

Multi-Centre RCT of the use of TXA in traumatic brain injury
Inclusion – Adult trauma patients within 3hrs of injury with ≥1 of
- GCS ≤12
- Intracranial bleed on imaging
- No other significant bleed (as they would likely get any way post Crash 2)
Treatment – 1g TXA IV over 10min then a second 1g TXA IV over 8hrs
Outcome – Significant reduction in Death with NO increase in clots(thrombotic disease)
- On metanalysis within paper benefit shown for all patients
- Results of this paper showed the largest benefit is in:
  - Mild-Mod Head injury (GCS9-15)
  - Patients with reactive pupils

This video explains it brilliantly and shows why early administration is so important!

Inhibits fibrinolysis – i.e. stops plasmin breaking down clots
Treats bleeding – NOT coagulopathy
Given TXA Early – as tPA activates early and PIA-1 is later, we need to stop the tPA
- 15min treatment delay > 10% reduction in effect
Give on the suspicion of bleeding? – you get the same risk reduction what ever your base line risk (i.e. 30% risk of death > 20%, 3% risk > 2%)
Safety – in Japan TXA bought over the counter for headaches
RCT’s
- Surgery – TXA reduces blood loss by 1/3 & death, NO increase in clot events
- Post-Partum Haemorrhage – PPH reduced by 1/3
- Trauma – Sig. reduction in DEATH (<1hr reduced by 1/3, 1-3hr by 1/5)
- Vascular occlusive events – data seems to show TXA reduces them
  - Bad bleeding increases vascular-occlusive events
- Brain – Given with in 3hrs reduces deaths
- GIT – results due next yea, recruitment stopped in uk as TXA was being give anyway
Why have the infusion? – added to regime to (theoretically) replace the loses from ongoing bleed, its utility is unknown.