Tranexamic acid (txa)

[Goon]

Good morning Gentlemen,

I am curious as to any input the group has on the use of Tranexamic acid (txa) in the field real world. I have read the Crash study after talking to Mr. Proulx and Mr. Compton at TCMC and would like to know the real world application in the field and the opinion of the more educated than myself. I know as a non SOF medic it is out of the scope of practice for me but I am always trying to educate myself on new techniques and practices.

I understand the dosage, route and practical theory along with timelines to administer but hearing first hand usage accounts helps my understanding.

If I am out of line, I mean no disrespect.

[RockyFarr]

Works better than Factor VIIa but needs to be given IV push in fluids before 3 hours after wounding.

[swatsurgeon]

Originally Posted by RockyFarr

Works better than Factor VIIa but needs to be given IV push in fluids before 3 hours after wounding.

Col.,
Welcome aboard, please add where ever you see fit.

Goon,
as mentioned has to be given <3 hrs from wounding...several issues from the two major studies done on the drug in Trauma (CRASH-2 and MATTERS trials)
- this is an antifibrinolytic......prevents breakdown of naturally occuring clot, so need clot for this to work and in the civilian world with aspirin, coumadin, plavix....no clot!!
- CRASH-2 study showed a 1.5% reduction in all cause mortality, over 20,000 patients in >200 hospitals in 40 countries.....see any potential problems yet??
The MATTERS trial, >900 patients treated at military facility in Afganistan with more severly injured and better results relative to survival benefit. Was a retrospective study and dosing was all over the place at the discretion of the treating team but usually given within 1 hr of wounding.
Our problem is the civilian world is not made up of young healthy, in shape soldiers with greater prehospital care available....give me an 18D ANYDAY!!!!! vs civilain EMS for the most part (just a generalized statement, don't shoot me for that one)
Benefits: low cost, longer window of opportunity it seems. Just don't know yet about our (civilian trauma) population efficacy.

Hope this helps

ss