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The Use of Tranexamic acid (TXA) for The Management of Haemorrhage In Trauma Patients In The Prehospital Environment

Literature Review and Descriptive Analysis of Principal Themes

Stansfield, Rachel*; Morris, Danielle; Jesulola, Emmanuel*,†

doi: 10.1097/SHK.0000000000001389
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ABSTRACT Tranexamic acid (TXA) is an anti-fibrinolytic agent used to prevent traumatic exsanguination. It was first introduced to clinical practice for the management of patients with bleeding disorders, especially adapted to reduce bleeding in haemophiliacs undergoing oral surgical interventions. TXA exerts its action on the coagulation process by competitively inhibiting plasminogen activation, thereby reducing conversion of plasminogen into plasmin. This ultimately prevents fibrinolysis and reduces haemorrhage. Thus, TXA may be well suited for the management of traumatic haemorrhage in the pre-hospital setting.

Despite multiplicity of studies on the use of TXA in clinical practice, there is no consensus regarding the use of TXA for the management of haemorrhage in trauma patients in the prehospital environment. Thus, a review on this topic was warranted. An extensive literature search yielded 14 full journal articles which met the inclusion criteria. These articles were thoroughly analysed and the and following themes were identified: “Dose of TXA administration”, “Route of TXA administration”, “Optimal window of TXA administration”, “Safety of TXA use”, “Clinical Effectiveness of TXA application” and the “Feasibility of TXA use in the prehospital setting”.

Overall, to achieve the best possible outcomes, literature supports the use of a loading dose of 1 gram of TXA, followed by 1 gram infusion over 8 hours, given by intravenous administration within a 3 hour window period of traumatic injury. TXA is very effective and safe to use in the pre-hospital setting, and its use is clinically and economically feasible.

*Paramedicine Discipline, Charles Sturt University, Bathurst NSW 2795, Australia

Bathurst Base Hospital, Bathurst NSW 2795, Australia

Address reprint requests to Dr Emmanuel Jesulola, Room 206, Building 1448, Charles Sturt University, Panorama Avenue, Bathurst, NSW 2795 Australia. E-mail: ejesulola@csu.edu.au

Received 4 April, 2019

Revised 18 April, 2019

Accepted 14 May, 2019

Funding: No funding was required for this review article.

Disclosure of interest: The authors report no conflict of interest.

© 2019 by the Shock Society