TXA – Tranexamic Acid

TXA a bleeding wonder drug!

Crash 2 Study (2010)

  • 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)

Crash 3 Study (2019)

  • 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

Mechanism of action

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

Author comments (Dr Ian Roberts @ RCEMasc 2019)

  • 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.

 

 

 

 

 

 

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