Use of Tranexamic Acid in Pre-Hospital an Emergency Medicine - Research Paper Example

Tranexamic Acid And Its Uses In Pre-Hospital An Emergency Medicine Tranexamic Acid And Its Uses In Pre-Hospital An Emergency Medicine Tranexamic acid is anti-fibrinolytic agent which prevents breakdown of fibrin clots. The mechanism of action of the drug is a complex one. The acid initially acts by hindering the binding of plasminogen and plasmin. Tranexamic acid has more potency and efficacy than aminocaproic acid. Tranexamic acid is used in emergency medical conditions. The drug is used in prevention of postoperative bleeding disorders such as hemophilia. The drug proves to very useful in treating conditions such as menorrhagia, epistaxis, angioedema, surface bleeding from tumors. In conditions such as DIC tranexamic acid should not be used. The acid should not be used because it works against clots and hence activates intravascular coagulation and platelet usage. If a person with DIC is administered with the acid they end up having end-organ damage due to microvascular pathologies. The unwanted effects of the drug include nausea, vomiting, diarrhea, hypotension and disturbances in vision. Tranexamic acid is used topically. The acid is excreted in the urine (Twycross et al, 2002). Tranexamic acid has lately been used in emergency medical scenarios. Even though hemostatic dressings and tourniquets have prevented conditions such as hemorrhagic shock, the usage of tranexamic acid can have the same effect. This drug has been used for a long time in cardiac surgeries and bleeding disorders such as hemophilia. Now it is being used in taking care of hemodynamic conditions. A study by the name of Clinical Randomization of an Antifibrinolytic in Significant Hemmorrhage 2 (CRASH-2) tested 20000 patients with tranexamic acid across various countries. The results of the study showed that in an emergency trauma center where patients had serious bleeding, tachycardia and hypotension were given tranexamic acid. The recipients of TXA had a mortality of 14.5 %. Hence patients receiving TXA were at benefit. Another study is the Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) was carried out which involved TXA infusion in an out-patient hospital. Tranexamic acid was administered in patients in which hemorrhagic shock was suspected. The results of the MATTERs study showed that individuals who received TXA had a mortality of 17.4% (Goodloe, 2013). USE OF TRANEXAMIC ACID FOR TREATING POSTPARTUM HEMORRHAGE Annually more than 500000 women lose their lives to postpartum events such as childbirth. Obstetric hemorrhage cause increased rates of maternal mortality. Hence systemic fibrinolytic agents are used in surgeries to prevent fibrinolysis to avoid blood loss after surgeries. A study by the name of WOMAN Trial was carried out which studied the usage of TXA for treatment of postpartum hemorrhage. The study was a randomized trial that determined the effect of TXA on mortality, hysterectomy and other morbid conditions. The study was a randomized double blinded placebo trial. In which 15000 women were tested. The women that qualified for the test were legally adult women with diagnosed postpartum hemorrhage following a vaginal or caesarean deliveries. Women were given a 1 gram dose of TXA or a placebo. The results were in favor of TXA administration (Shakur et al, 2010). Another study was also carried out to investigate emergency conditions such as postpartum hemorrhage. The study was held to determine if an infusion of high dose tranexamic acid at the time of postpartum hemorrhage diagnosis could decrease the blood loss. This study too was a randomized trial which assessed women with postpartum hemorrhage more than 800 ml. The results of the study showed that high doses of TXA can reduce blood loss and morbidity rates in women with postpartum hemorrhage. Though this study was substantial a larger study is still needed to confirm that high doses of tranexamic acid reduces maternal morbidity by postpartum hemorrhage (Ducloy-Bouthors et al, 2011). USE OF TRANEXAMIC ACID IMPROVE TRAUMA MORTALITY Trauma is an emergency condition and is a leading cause of death in the world. The primary cause of traumatic death is injury and the secondary cause of traumatic death is exsanguination. In emergency conditions such as massive blood loss the coagulation system responds by activating the breakdown of blood clots which can prove to be dangerous. Hence in such conditions a cheap anti-fibrinolytic agent such as tranexamic acid can be infused. The acid is responsible in inhibiting in minimizing coagulopathy caused by trauma. It does this by hindering fibrinolysis leading to reduced blood loss. Available sources show that TXA administration reduces mortality in bleeding patients (Harvey et al, 2014). USE OF TRANEXAMIC ACID IN A WIDE SPECTRUM OF PATIENTS A study was carried out which examined if administration of tranexamic acid had varied results on individuals with different magnitudes of trauma. More than 13000 trauma patients were given TXA within three hours of trauma. The results depicted that tranexamic acid administration was related to a reduction in all cases of mortality and deaths from bleeding. In every magnitude of trauma, deaths were the least where TXA infusion had occurred. Hence it was concluded that TXA can be given to a variety of patients with bleeding traumatic conditions and not only to those who are severly injured (Salvucci, 2012). USE OF TRANEXAMIC ACID TO REDUCE MORTALITY IN EMERGENCY SURGERIES Emergency situations include urgent surgeries that lead to saving lives. Tranexamic acid has shown reduced levels of perioperative bleeding. Its administration has also shown reduced needs of blood transfusions in patients undergoing surgery. A study was conducted in which five trials were scrutinized out of which three gave substantial data. The study concluded that tranexamic acid reduced the possibility of blood transfusion in patients who were going through emergency surgical procedures (Perel et al, 2013). TREATING TRAUMA IN COMBAT SITUATIONS Studies have been carried out which study the application of tranexamic acid in military men. The study suggested that 1 gram of tranexamic acid should be infused as an intramuscularly to combat troops to counter events of suffering severe injury. Early administration of tranexamic acid in traumatic emergency conditions has shown to be advantageous in preventing death from bleeding in trauma patients either they are in the military or civilians. The study concludes that tranexamic acid is an easy and cheap remedy to save lives. The study also summarizes that the use of tranexamic acid is a logical step to counter deaths by trauma (Wright, 2013). CONCLUSION Tranexamic acid is a potent anti-fibrinolytic agent that acts by binding plasminogen and by hindering the bonding of plasmin to fibrin. Patients with bleeding disorders such as hemophilia have been using this drug for a long time and now its use in emergency conditions is becoming common. Tranexamic acid has been the core of various studies and trials. It has been in post-traumatic and post-surgical conditions. In various cases tranexamic acid also reduced transfusion requirements associated with surgery. Its application also reduced blood loss in gynecological bleeding disorders, such as heavy menstrual bleeding or menorrhagia and postpartum hemorrhage. It can be concluded that tranexamic acid is tolerated among masses. Most studies and trials have proved that it is a potent, effective, reliable and cheap anti-fibrinolytic agent. Its uses in emergency scenarios proves to be amazing as it is responsible in providing mortality. Its role in emergency situations such post-combat trauma are commendable. The drug has proved to be a life savior in many surgical procedures also. It can also be administered in surgeries to counter blood loss. Hence it can be concluded that keeping all of the magnitudes of trauma in mind, tranexamic acid can avoid death by trauma or excessive bleeding. Even though it is a useful agent further studies are required on international basis to understand the drug and its attributes completely. References Ducloy-Bouthors, A. S., Jude, B., Duhamel, A., Broisin, F., Huissoud, C., Keita-Meyer, H., ... & Susen, S. (2011). High-dose tranexamic acid reduces blood loss in postpartum haemorrhage. Crit Care, 15(2), R117. Goodloe, J. M., Howerton, D. S., McAnallen, D., & Reed, H. (2013). How can tranexamic acid help in EMS? TXA offers new hope for an old challenge in traumatic hemorrhagic shock. EMS world, 42(5), I5. Harvey, V., Perrone, J., & Kim, P. (2014). Does the Use of Tranexamic Acid Improve Trauma Mortality?. Annals of emergency medicine, 63(4), 460-462. Perel, P., Ker, K., Morales Uribe, C. H., & Roberts, I. (2013). Tranexamic acid for reducing mortality in emergency and urgent surgery. Cochrane Database Syst Rev, 1. Salvucci, A. (2014). Literature Review: Is TXA Safe for Lesser Injuries? EMS World. Retrieved from http://www.emsworld.com/article/10827225/which-traumatic-bleeding-patients-can-tranexamic-acid-help Shakur, H., Elbourne, D., Gülmezoglu, M., Alfirevic, Z., Ronsmans, C., Allen, E., & Roberts, I. (2010). Study protocol The WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double blind placebo controlled trial. Twycross, R. G. (2002). Palliative care formulary. Abingdon, Oxon: Radcliffe Medical Press. Wright, C. (2013). Battlefield administration of tranexamic acid by combat troops: a feasibility analysis. Journal of the Royal Army Medical Corps, jramc-2013. Read More