Enthusiasm for Prehospital Use of TXA May Be Premature

Tranexamic acid (TXA), an antifibrinolytic drug, has been used by clinicians since 1986 when it was first approved by the Food and Drug Administration for the reduction and prevention of hemorrhage in patients with hemophilia undergoing tooth extraction. Since then, it's been used as an "off-label" medication in cardiac and orthopedic surgery as a means to reduce intraoperative blood loss. Recently this off-label use has expanded to trauma patients based on enthusiasm from two studies known as CRASH-2 and MATTERS (discussed later). Today TXA is used in some hospitals in the United States, and there's been increasing interest in expanding its use to prehospital care. The April 2015 JEMS article "TXA in the USA: Tranexamic acid's potentially bright future relies on collaborative data," by Jeffrey M. Goodloe, MD, NRP, FACEP and Ryan Gerecht, MD, CMTE, highlighted many of the points that advocates of expanded use have been making.1 Other articles and press releases about the use of TXA by EMS have provided similar information regarding the drug.2 However, these articles have, for unclear reasons, failed to objectively critique the listed studies or failed entirely to mention studies that paint even a slightly negative view of TXA. There are many issues regarding the use of this drug for trauma patients that haven't been answered, which is why many in the trauma surgeon community haven't yet come out in favor of its unbridled use. As a trauma surgeon and m...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Trauma Source Type: news