Can Giving Tranexamic Acid to Trauma Patients Cause Harm?
- Tag: bleeding, blood, CRASH-2, critical care, fibrinolysis shutdown, hemodynamics, hyperfibrinolysis, massive hemorrhage, Meizoso, mortality, Prehospital, research, TEG, tranexamic acid, transfusion, trauma, TXA, viscoelastic study
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Now that all they hype from the CRASH-2 study which was published in 2010 has died down and all of the sub-analyses seemed to have been published, there is some growing concern that tranexamic acid (TXA) may cause harm if given indiscriminately. While some quote the lack of demonstrable complications in a 20,000 patient randomized controlled trial, even in vascular thromboembolic events as evidence to TXA’s safety, it just doesn’t seem to pass muster that a drug which significantly inhibits clot breakdown to the point that it provides a mortality benefit, would not have any downside. Meizoso et al. rides the wave of this skepticism, trying to add to the general knowledge of how/when/if tranexamic acid should be administered in trauma.
Joshua Sappenfield attempts to graze the surface behind TXA’s rise and fall in popularity with this editorial. He has given several talks on TXA and it’s use in trauma. He currently is at the University of Florida and has numerous research interests including trauma, simulation, and quality. He is also involved with the Trauma Anesthesiology Society.