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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, March 22, 2016

TXA Matters

emDocs - March 21, 2016 - Authors: DeWeert D and Lovell E
Edited by: Koyfman A & Bright J
  • TXA is a safe, inexpensive ($100/dose) medication that prevents fibrin breakdown. In traumatic bleeding, it conveys a significant mortality benefit with an impressive NNT for mortality between 7 and 67, depending on injury severity, without apparent serious safety issues. This benefit is associated with early administration. TXA should not be given more than three hours after injury as it may increase mortality after this timeframe. It appears to have equal benefit in a variety of trauma practice environments.
  • TXA has been included in the WHO’s List of Essential Medicines and is included in various trauma protocols worldwide, such as the UK Defense Medical Service’s massive transfusion protocol. The UK Royal College of Pediatrics and Child Health’s Nov 2012 evidence statement proposes the use of TXA in all children. According to a 2011 review in J Trauma, TXA should be incorporated into trauma clinical practice guidelines and treatment protocols for bleeding trauma patients as it is the only drug with prospective clinical evidence supporting this application.
  • Although there is a robust history of using TXA in surgery to reduce perioperative hemorrhage, evidence for its effectiveness in acute conditions is more limited. Large trials evaluating its use in traumatic brain injury, postpartum hemorrhage, and gastrointestinal bleeding are ongoing."