An Interdisciplinary Literature Review of Prehospital Use of Tranexamic Acid (TXA) in Major Bleeding

An interdisciplinary literature review Discovered in the 1950s, tranexamic acid (TXA) is an antifibrinolytic medication that, over the last decade, has drawn considerable attention from researchers, clinicians and mainstream media.1 TXA is a synthetic chemical that’s a competitive antagonist to the lysine binding site of plasminogen.2 When a fibrin clot forms in the body in response to bleeding, it’s naturally degraded over time. In major trauma and hemorrhage, it’s thought that the body’s fibrin degradation process is accelerated due to high levels of fibrinolytic factors in circulation.3 This contributes to a lethal downward spiral causing severe dysregulation, annihilation of the body’s clotting process, and ultimately death due to hemorrhage. This is termed hyperfibrinolysis (HF).4,5 Enter TXA, the inhibitor of fibrin-degradation. By blocking the activation of plasminogen to plasmin, the body’s normal process of fibrin degradation is hindered. This is favorable in the setting of massive hemorrhage due to trauma—clots will remain viable and abate hemorrhage as originally intended. This drug is routinely used around the world in various settings of major hemorrhage. It can be purchased over the counter in Japan for heavy menses. TXA is typically given in major bleeding prehospitally. Other implications of its use which have been identified and validated include postpartum hemorrhage, gastrointestinal bleeding, knee arthroplasty, coronary artery bypass, and sev...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Trauma Patient Care Source Type: news