Abby M Bailey, Stephanie N Baker, Kyle A Weant
Trauma-related deaths represent a leading cause of mortality among persons younger than 45 years. A significant percentage of these are secondary to hemorrhage. In trauma, massive and rapid loss of blood creates an imbalance in hemostasis. Mainstays of resuscitation include surgical interventions, restoring intravascular volume, and pharmacologic interventions. Providers continue to search for improved pharmacologic options for achieving hemostasis. Tranexamic acid is an antifibrinolytic and inhibits fibrinolysis by blocking the lysine-binding sites on plasminogen...
April 2014: Advanced Emergency Nursing Journal
K Ker, D Prieto-Merino, I Roberts
BACKGROUND: Tranexamic acid (TXA) reduces blood transfusion in surgery but the extent of the reduction in blood loss and how it relates to the dose of TXA is unclear. METHODS: A systematic review of randomized trials was performed. Data were extracted on blood loss from trials comparing intravenous TXA with no TXA or placebo in surgical patients. A Bayesian linear regression was used to describe the relationship between the reduction in blood loss with TXA and the extent of bleeding as measured by the mean blood loss in the control group...
September 2013: British Journal of Surgery
P Perel, D Prieto-Merino, H Shakur, I Roberts
BACKGROUND: Severe bleeding accounts for about one-third of in-hospital trauma deaths. Patients with a high baseline risk of death have the most to gain from the use of life-saving treatments. An accurate and user-friendly prognostic model to predict mortality in bleeding trauma patients could assist doctors and paramedics in pre-hospital triage and could shorten the time to diagnostic and life-saving procedures such as surgery and tranexamic acid (TXA). OBJECTIVES: The aim of the study was to develop and validate a prognostic model for early mortality in patients with traumatic bleeding and to examine whether or not the effect of TXA on the risk of death and thrombotic events in bleeding adult trauma patients varies according to baseline risk...
June 2013: Health Technology Assessment: HTA
I Roberts, H Shakur, T Coats, B Hunt, E Balogun, L Barnetson, L Cook, T Kawahara, P Perel, D Prieto-Merino, M Ramos, J Cairns, C Guerriero
BACKGROUND: Among trauma patients who survive to reach hospital, exsanguination is a common cause of death. A widely practicable treatment that reduces blood loss after trauma could prevent thousands of premature deaths each year. The CRASH-2 trial aimed to determine the effect of the early administration of tranexamic acid on death and transfusion requirement in bleeding trauma patients. In addition, the effort of tranexamic acid on the risk of vascular occlusive events was assessed...
March 2013: Health Technology Assessment: HTA
Joseph F Rappold, Anthony E Pusateri
With the advent of remote damage control resuscitation and far-forward surgery, a renewed emphasis has been placed on examining a variety of pharmacologic adjuncts to controlling blood loss before definitive operative intervention. In this paper, the authors review the current state of the art for tranexamic acid (TXA) and its potential benefits to those patients who are in need of a massive transfusion. Specifically addressed are its biologic and pharmacologic properties, as well the results of a number of recent studies...
January 2013: Transfusion
Anthony E Pusateri, Richard B Weiskopf, Vikhyat Bebarta, Frank Butler, Ramon F Cestero, Irshad H Chaudry, Virgil Deal, Warren C Dorlac, Robert T Gerhardt, Michael B Given, Dan R Hansen, W Keith Hoots, Harvey G Klein, Victor W Macdonald, Kenneth L Mattox, Rodney A Michael, Jon Mogford, Elizabeth A Montcalm-Smith, Debra M Niemeyer, W Keith Prusaczyk, Joseph F Rappold, Todd Rassmussen, Francisco Rentas, James Ross, Christopher Thompson, Leo D Tucker
A recent large civilian randomized controlled trial on the use of tranexamic acid (TXA) for trauma reported important survival benefits. Subsequently, successful use of TXA for combat casualties in Afghanistan was also reported. As a result of these promising studies, there has been growing interest in the use of TXA for trauma. Potential adverse effects of TXA have also been reported. A US Department of Defense committee conducted a review and assessment of knowledge gaps and research requirements regarding the use of TXA for the treatment of casualties that have experienced traumatic hemorrhage...
February 2013: Shock
Ian Roberts, Pablo Perel, David Prieto-Merino, Haleema Shakur, Tim Coats, Beverley J Hunt, Fiona Lecky, Karim Brohi, Keith Willett
OBJECTIVES: To examine whether the effect of tranexamic acid on the risk of death and thrombotic events in patients with traumatic bleeding varies according to baseline risk of death. To assess the extent to which current protocols for treatment with tranexamic acid maximise benefits to patients. DESIGN: Prespecified stratified analysis of data from an international multicentre randomised controlled trial (the CRASH-2 trial) with an estimation of the proportion of premature deaths that could potentially be averted through the administration of tranexamic acid...
September 11, 2012: BMJ: British Medical Journal
Anna Morgan, Anna Jeffrey-Smith
A short cut review was carried out to establish whether tranexamic acid should be given to patients having an upper gastrointestinal bleed. Seven studies and two systematic reviews were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that there is insufficient evidence, at the moment, to recommend the use of tranexamic acid in the management of upper gastrointestinal bleeding...
September 2012: Emergency Medicine Journal: EMJ
Paul L McCormack
Tranexamic acid, a synthetic derivative of the amino acid lysine, is an antifibrinolytic agent that acts by binding to plasminogen and blocking the interaction of plasmin(ogen) with fibrin, thereby preventing dissolution of the fibrin clot. Tranexamic acid (Transamin®) is indicated in Japan for use in certain conditions with abnormal bleeding or bleeding tendencies in which local or systemic hyperfibrinolysis is considered to be involved. This article reviews the efficacy and tolerability of tranexamic acid in conditions amenable to antifibrinolytic therapy and briefly overviews the pharmacological properties of the drug...
March 26, 2012: Drugs
Jonathan J Morrison, Joseph J Dubose, Todd E Rasmussen, Mark J Midwinter
OBJECTIVES: To characterize contemporary use of tranexamic acid (TXA) in combat injury and to assess the effect of its administration on total blood product use, thromboembolic complications, and mortality. DESIGN: Retrospective observational study comparing TXA administration with no TXA in patients receiving at least 1 unit of packed red blood cells. A subgroup of patients receiving massive transfusion (≥10 units of packed red blood cells) was also examined...
February 2012: Archives of Surgery
Ian Roberts, Haleema Shakur, Adefemi Afolabi, Karim Brohi, Tim Coats, Yashbir Dewan, Satoshi Gando, Gordon Guyatt, B J Hunt, Carlos Morales, Pablo Perel, David Prieto-Merino, Tom Woolley
BACKGROUND: The aim of the CRASH-2 trial was to assess the effects of early administration of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage. Tranexamic acid significantly reduced all-cause mortality. Because tranexamic acid is thought to exert its effect through inhibition of fibrinolysis, we undertook exploratory analyses of its effect on death due to bleeding. METHODS: The CRASH-2 trial was undertaken in 274 hospitals in 40 countries...
March 26, 2011: Lancet
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