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




Monday, June 28, 2021


First10EM - By Justin Morgenster - June 28, 2021
Taken together, I think these studies make it clear that TXA is not a miracle cure. It might have a small physiologic effect, but there are more negative trials than there are positive. With the sole exception of CRASH-2, the high quality studies are all negative. The rest of the benefit is seen in disease oriented outcomes in small, low quality studies. That really makes me wonder whether CRASH-2 represents a false positive, outlying result. The only way to know would be a repeat study, which seems unlikely, but – although we tend to ignore the fact in medicine – replication is the foundation of science.
My personal feeling, informed by the totality of the TXA literature, is that a CRASH-2 replication has a high probability of being negative – that there is still equipoise. If such a study were done in a country with an advanced trauma system, it is even more likely to be negative. However, the best available evidence at this point supports TXA in bleeding trauma patients.
Clinically speaking, I use TXA in bleeding trauma patients. I don’t use it in isolated traumatic brain injury. I don’t use it in spontaneous intracranial hemorrhage or subarachnoid hemorrhage. I don’t use it in postpartum hemorrhage. I don’t use it for gastrointestinal bleeding. I have been using it in epistaxis, but should probably stop.
For most other indications, the science is too uncertain to make strong conclusions. In totality, TXA seems to have a very small effect (if any). It probably shouldn’t be used routinely for any indication. Harms are probably small, and probably even smaller when used topically, but shouldn’t be overlooked. For select patients with bleeding issues, especially those uncontrolled by other means, it may still be reasonable to try TXA while waiting for more research to be done."