First Approval of TXA?
First approved by the FDA in 1986 as a short course injection (2-8 days), TXA intravenous (IV) solution and oral tablets prevented bleeding in hemophilia patients during tooth extraction.
What does TXA do? In four words, TXA reduces blood loss. In trauma, the indications for TXA are in patients with massive bleeding.
Secondary to the initial trauma, associated trauma-induced coagulopathies (TIC) cause significant mortality. Data from the international 2010 CRASH-2 (Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage) involving over 20,000 patients showed survival after TXA administration increased when compared to placebo.
The CRASH-2 trial evaluated TXA effects with early administration in trauma and vascular occlusive events. In contrast to early data from CRASH-1, the CRASH-3 trial found that TXA reduced head injury death in patients with TBI.
To reduce death, TXA administration should occur within 3h of injury.
TXA Trauma Protocol:
- Administer within 3 hours of injury
- Within the activation of MTP (massive transfusion protocol)
- Systolic blood pressure < 90mmHg
Contraindications:
Adverse Effects:
- Anaphylaxis
- Thrombosis
- Hypotension (with rapid infusion, with rate > 100mg/min)
- Nausea, vomiting, diarrhea
- Visual Changes; blurred, color
