Tranexamic Acid update

red_blood_cellsSince the CRASH2 trial was published in 2010, there has been a huge amount of work to ascertain how best to deliver tranexamic acid practically, particularly in the prehospital environment.

The benefits of tranexamic acid almost seemed too good to be true.  It’s cheap, easy to carry, has been used for decades within hospital and GP settings – and seems to offer absolute benefits in promoting haemostasis, with no side effects.  It also fits very well into the ‘damage limitation’ approach that has changed much of prehospital trauma care over the last few years.  In addition, military experience, particularly from Afghanistan, has accelerated the availability of high quality practical data on its use in challenging environments.

Now, there is some solid and pragmatic advice on the administration of tranexamic acid, including a Cochrane review which has been published in December last year:

>> Blood-clot promoting drugs for acute traumatic injury

It appears that it is now at a point that many practitioners can and should be considering its use.  Especially for areas where transfer to a surgical or major trauma unit is likely to be delayed – such as rural and remote areas of Scotland – it could offer vital life-saving benefits of reduced blood loss and extended survival times in the context of major trauma.

Administration is relatively straightforward.  Where there is evidence of a ‘positive primary survey’ – i.e. where pulse, blood pressure/capillary refill time or respiration rate are impaired due to suspected haemorrhage, resulting from trauma in the last 3 hours, the following treatment is suggested:

  • Inject two 500mg vials (1g) of tranexamic acid into a 100mL bag of normal saline.  Give this IV over 10-20 minutes (loading dose).
  • Inject two 500mg vials (1g) of tranexamic acid into a 500mL bag of normal saline.  Give this IV over 8 hours (maintenance dose).

Commonly, where transfer to hospital or extrication takes less than 30 minutes, the maintenance dose can be more safely given once the patient is in a facility that can provide an IV pump to give this over a more exact time.

httpv://www.youtube.com/watch?v=7oekncvAXGs

 

Crash 3 Trial

The investigators are now busy conducting the Crash 3 trial which will look at the effects of tranexamic acid specifically on traumatic brain injury.  They’ve produced a video explaining the new trial procedure – which also highlights some of the key points of using tranexamic acid above.

httpv://www.youtube.com/watch?v=7jdjSAiiCmc

 

 

 

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2 Responses to Tranexamic Acid update

  1. Simon van Lieshout February 3, 2013 at 1:18 pm #

    Thanks David
    I’ve been mulling this over for a while, and almost ordered it whilst I was in a rural highland practice recently as their bags don’t have it and they respond to RTAs. However the last time I tried to order it from a chemist they failed to source it. Is it relatively easy to source or have others come across problems getting hold of it?
    Cheers
    Simon van Lieshout

  2. Blog Editor
    Blog Editor February 3, 2013 at 9:51 pm #

    Hi Simon,
    I haven’t had any problems and ordered it recently through a stock order form from our community pharmacy. I know our community hospital has had it in stock for some time for other purposes too.

    If you have a BNF website login, follow this link… http://www.medicinescomplete.com/mc/bnf/current/PHP1603-cyklokapron.htm#PHP1603-cyklokapron

    Hope this helps. Remember to carry 2 vials (for the loading dose at least), and a bag of 100mL saline with giving set.

    David

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