Tranexamic acid use in emergency medicine

Abstract

The most common cause of potentially preventable trauma deaths is hemorrhage. Therefore, it is crucial to understand the mechanisms regulating bleeding and clotting. The physiological mechanisms that control the coagulation process are called the coagulation cascade. In this study, we analyzed the medical literature for published articles on the use of TXA for bleeding. The MEDLINE electronic database was searched for. The keywords we have used were: “tranexamic acid”, “bleeding”, “hemorrhage”, “treatment”, “prevention”, “patient blood management”, “anti-fibrinolytic”, “surgery”, “surgery”, “trauma”, “injury” and “traumatic brain injury”. When managing the traumatic patient, time is of the essence and the same holds true for the TXA application. The largest study regarding the use of TXA in the emergency medicine CRASH-2 found that the administration of TXA within 3 hours following injury significantly reduces the mortality and that every 15-min delay in administering TXA results in increased bleeding and decreased survival by 10%, offering no benefit if administered after 3 hours. In summary, TXA is a safe and reliable agent which greatly increases the survival rate in traumatic patients suffering blood loss, reducing mortality while being safe.