Tranexamic Acid Treatment for Trauma Victims

2021 ◽  
Author(s):  
Ian Roberts ◽  
Amy Brenner ◽  
Haleema Shakur-Still
Keyword(s):  
Tranexamic Acid ◽  
Traumatic Injury ◽  
Low Risk ◽  
Baseline Risk ◽  
Trauma Patients ◽  
Wide Range ◽  
Risk Patients ◽  
Polytrauma Patients ◽  
Time Critical ◽  
Proportional Reduction

AbstractWorldwide, traumatic injury is responsible for over 5 million deaths per year, the majority due to exsanguination and head injury. The antifibrinolytic drug tranexamic acid is the only drug proven to reduce deaths after traumatic injury. Several large randomized controlled trials have provided high-quality evidence of its effectiveness and safety in trauma patients. Early tranexamic acid reduces deaths on the day of the injury in polytrauma patients and patients with isolated traumatic brain injury by around 20%. Treatment is time critical; for patients to benefit, tranexamic acid must be given as soon as possible after injury. Intramuscular administration is well tolerated and rapidly absorbed, with the potential to reduce time to treatment. Because the proportional reduction in bleeding death with tranexamic acid does not vary by baseline risk, a wide range of trauma patients stands to benefit. There are far more low-risk trauma patients than high-risk patients, with a substantial proportion of bleeding deaths in the low-risk group. As such, treatment should not be limited to patients with severe traumatic hemorrhage. We must give paramedics and physicians the confidence to treat a far wider range of trauma patients while emphasizing the importance of early treatment.

scholarly journals Prehospital resuscitation

2021 ◽  
Vol 6 (1) ◽  
pp. e000729
Author(s):  
Alexandra M P Brito ◽  
Martin Schreiber
Keyword(s):  
Young People ◽  
Tranexamic Acid ◽  
New Technologies ◽  
Blood Product ◽  
Traumatic Injury ◽  
Trauma Patients ◽  
Blood Products ◽  
Front Line ◽  
The Usa ◽  
Review Current

Traumatic injury is the leading cause of death in young people in the USA. Our knowledge of prehospital resuscitation is constantly evolving and is often informed by research based on military experience. A move toward balanced blood product resuscitation and away from excessive crystalloid use has led to improvements in outcomes for trauma patients. This has been facilitated by new technologies allowing more front-line use of blood products as well as use of tranexamic acid in the prehospital setting. In this article, we review current practices in prehospital resuscitation and the studies that have informed these practices.

scholarly journals USE OF TRANEXAMIC ACID IN TRAUMA PATIENTS: AN ANALYSIS OF COST-EFFECTIVENESS FOR USE IN BRAZIL

2016 ◽  
Vol 29 (4) ◽  
pp. 282-286 ◽  
Author(s):  
Marcelo A. PINTO ◽  
◽  
Jair G. da SILVA ◽  
Aljamir D. CHEDID ◽  
Marcio F. CHEDID ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Tranexamic Acid ◽  
Massive Transfusion ◽  
Critical Evaluation ◽  
Population Data ◽  
Cost Effective ◽  
Hospital Environment ◽  
Trauma Patients ◽  
Wide Range ◽  
The Subject

ABSTRACT Introduction: Use of tranexamic acid (TXA) in trauma has been the subject of growing interest by researchers and health professionals. However, there are still several open questions regarding its use. In some aspects medical literature is controversial. The points of disagreement among experts include questions such as: Which patients should receive TXA in trauma? Should treatment be performed in the pre-hospital environment? Is there any need for laboratory parameters before starting TXA treatment? What is the drug safety profile? The main issue on which there is still no basis in literature is: What is the indication for treatment within massive transfusion protocols? Objective: Answer the questions proposed based on critical evaluation of the evidence gathered so far and carry out a study of cost-effectiveness of TXA use in trauma adapted to the Brazilian reality. Methods: A literature review was performed through searching Pubmed.com, Embase and Cab Abstract by headings "tranexamic AND trauma", in all languages, yielding 426 articles. Manuscripts reporting on TXA utilization for elective procedures were excluded, remaining 79 articles. Fifty-five articles were selected, and critically evaluated in order to answer study questions. The evaluation of cost effectiveness was performed using CRASH-2 trial data and Brazilian official population data. Results: TXA is effective and efficient, and should be administered to a wide range of patients, including those with indication evaluated in research protocols and current indication criteria for TXA should be expanded. As for the cost-effectiveness, the TXA proved to be cost-effective with an average cost of R$ 61.35 (currently US$16) per year of life saved. Conclusion: The use of TXA in trauma setting seems to be effective, efficient and cost-effective in the various groups of polytrauma patients. Its use in massive transfusion protocols should be the subject of further investigations.

scholarly journals Methods and Guidelines for Venous Thromboembolism Prevention in Polytrauma Patients with Pelvic and Acetabular Fractures

2015 ◽  
Vol 9 (1) ◽  
pp. 313-320 ◽  
Author(s):  
Francisco Chana-Rodríguez ◽  
Rubén Pérez Mañanes ◽  
José Rojo-Manaute ◽  
José Antonio Calvo Haro ◽  
Javier Vaquero-Martín
Keyword(s):  
Venous Thromboembolism ◽  
Vena Cava ◽  
Acetabular Fractures ◽  
Trauma Patients ◽  
Inferior Vena Cava Filters ◽  
Vena Cava Filters ◽  
Oral Agents ◽  
Venous Thromboembolism Prevention ◽  
Risk Patients ◽  
Polytrauma Patients

Sequential compression devices and chemical prophylaxis are the standard venous thromboembolism (VTE) prevention for trauma patients with acetabular and pelvic fractures. Current chemical pharmacological contemplates the use of heparins or fondaparinux. Other anticoagulants include coumarins and aspirin, however these oral agents can be challenging to administer and may need monitoring. When contraindications to anticoagulation in high-risk patients are present, prophylactic inferior vena cava filters can be an option to prevent pulmonary emboli. Unfortunately strong evidence about the most effective method, and the timing of their commencement, in patients with pelvic and acetabular fractures remains controversial.

Blunt Traumatic Injury to the Superficial Femoral Artery in a Morbidly Obese Female: Case Report Using Endovascular Covered Stent Repair

2020 ◽  
pp. 153857442095457
Author(s):  
Ahna H. Weeks ◽  
April A. Grant ◽  
Jason D. Sciarretta ◽  
Jonathan Nguyen ◽  
S. Rob Todd ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Endovascular Repair ◽  
Superficial Femoral Artery ◽  
Traumatic Injury ◽  
Covered Stent ◽  
Morbidly Obese ◽  
Trauma Patients ◽  
Stent Grafting ◽  
Obese Female ◽  
Wide Range

Lower extremity vascular injuries following trauma are rare events that require prompt identification and management in order to prevent ischemia and limb loss. Endovascular approaches, rather than traditional open procedures, are increasingly used to treat a wide range of vascular disease. The use of endovascular repair for revascularization in the trauma setting is not routine but may provide an appealing alternative in select trauma patients and injuries. We present a case of successful endovascular repair with stent grafting of a superficial femoral artery intimal injury following a femur fracture in a 35-year-old morbidly obese female and review the current literature regarding the use of endovascular therapy in the trauma setting.

scholarly journals Deep Venous Thrombosis (DVT) in Critically Ill Trauma Patients: There Are No Low Risk Patients

2010 ◽  
Vol 52 (2) ◽  
pp. 525
Author(s):  
Amir F. Azarbal ◽  
Susan Rowell ◽  
Jason Lewis ◽  
Shannon Moseley ◽  
Rakhee Urankar ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Critically Ill ◽  
Low Risk ◽  
Trauma Patients ◽  
Risk Patients

Influence of Tranexamic Acid on Inflammatory Signaling in Trauma

2020 ◽  
Vol 46 (02) ◽  
pp. 183-188
Author(s):  
Christopher D. Barrett ◽  
Yi Wen Kong ◽  
Michael B. Yaffe
Keyword(s):  
Tranexamic Acid ◽  
Inflammatory Responses ◽  
Traumatic Injury ◽  
Essential Medicines ◽  
World Health ◽  
Trauma Patients ◽  
Inflammatory Signaling ◽  
Inflammatory Signals ◽  
The World ◽  
Available Lysine

AbstractPlasmin generation in trauma patients has wide-ranging effects, from breakdown of clots to remodeling the extracellular matrix. An evolving recognition of plasmin as a critical effector molecule in various inflammatory signals and pathways has rendered the study of plasmin(ogen) and its regulation by upstream activators and downstream targets and inhibitors key to understanding the inflammatory responses to trauma. Tranexamic acid, a widely available lysine analogue medication on the World Health Organization's list of essential medicines, has rapidly become one of the most commonly implemented adjunct treatments for bleeding after traumatic injury in clinical practice. In this article, we review the effects, both anti- and proinflammatory, of tranexamic acid, with a focus on the injured trauma patient.

Tranexamic acid use in high-risk blood transfusion patients undergoing total hip replacement: a randomised controlled trial

2019 ◽  
pp. 112070001988994
Author(s):  
Osamu S Kimura ◽  
Emílio HCA Freitas ◽  
Maria EL Duarte ◽  
Amanda S Cavalcanti ◽  
Marco BC Fernandes
Keyword(s):  
High Risk ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Risk Group ◽  
Low Risk ◽  
Total Hip ◽  
High Risk Patients ◽  
Risk Patients ◽  
Randomised Controlled

Introduction: We hypothesised that a single preoperative intravenous dose of tranexamic acid (TXA) is effective in patients who undergo total hip arthroplasty (THA) and are at high risk of blood transfusion (preoperative haemoglobin level <13.0 g/dL). Methods: A prospective, randomised controlled study of 308 patients who underwent primary THA was conducted. 256 participants remained in the study and were divided into 2 major groups: high-risk group comprising 116 patients with preoperative Hb < 13.0 g/dL (57 of whom were treated with a 15 mg/kg intravenous bolus of TXA, and 59 of whom did not receive the medication) and low-risk group comprising 140 patients with Hb ⩾ 13.0 g/dL (71 of whom received the same dose of TXA, and 69 of whom did not). Participants were followed up at 3 weeks, 3 months, 6 months, and 1 year after surgery. Results: The use of TXA in both groups of patients significantly increased the levels of postoperative Hb and Ht. TXA protected high-risk patients from blood loss and from transfusion. In low-risk patients the use of TXA reduced blood loss but did not protect from blood transfusion. The median length of stay was significantly affected for high-risk patients. No thromboembolic event was recorded in either group. Conclusions: TXA reduces intra- and postoperative bleeding, transfusion rates, and the length of hospital stays in patients with low preoperative Hb. The use of TXA in patients with normal preoperative Hb reduces blood loss but does not affect the transfusion rate. ClinicalTrials.gov Identifier: NCT03019198

scholarly journals PS170. Deep Venous Thrombosis (DVT) in Critically Ill Trauma Patients: There Are No Low-Risk Patients

2010 ◽  
Vol 51 (6) ◽  
pp. 64S-65S
Author(s):  
Amir F. Azarbal ◽  
Susan Rowell ◽  
Jason Lewis ◽  
Shannon Moseley ◽  
Rakhee Urankar ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Critically Ill ◽  
Low Risk ◽  
Trauma Patients ◽  
Risk Patients

Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

2020 ◽  
Vol 29 (4) ◽  
pp. 1944-1955 ◽  
Author(s):  
Maria Schwarz ◽  
Elizabeth C. Ward ◽  
Petrea Cornwell ◽  
Anne Coccetti ◽  
Pamela D'Netto ◽  
...  
Keyword(s):  
At Risk ◽  
Allied Health ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Low Risk ◽  
False Negatives ◽  
Exact Agreement ◽  
Risk Patients ◽  
Impact Phase ◽  
Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

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