New Drug

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A new drug called tranexamic acid (TXA) is out for use in Ohio. The drug supposedly extends the body's initial fibrin response in severe external and internal bleeding until the patient can get into the operating room.

Thoughts?
 
We starting using it last year in Alberta. I know other provinces and services in the US are also using it.
It has also been around for a while.
 
Have you personally used it? What are your thoughts on it?
 
Crazy expensive with limited practical use.
 
I haven't used it, but a little while ago, it was the topic of conversation on TRAUMA-LIST. I've been a bit too busy to sit down and read the discussion about it.
 
From my limited knowledge of it it seems like the only real place for it in EMS is rural EMS.

Not something we carry or have even considered carrying that I'm aware of.
 
how rural is rural? you could probably call my town rural...but we are 10 mins away from L2 Trauma Center and 30 mins away from an L1 Trauma Center
 
Any Pt I see would be a minimum 2 hours from the closest hospital and 4-5 from any kind of trauma center. I have not given it yet but I am sure I will be at some point.
 
re

Listen to Dr. Weingarts Podcast he put out last year on this drug. Military has seen some good results with it.
 
TXA is cheap, effective, and has been used in the transplant community for years. The studies have been favorable, as mentioned above listen to the EMCRIT podcast on it.
 
The local helicopter services carry it, though that only started in the last year. Don't think any of our patients have received it yet.

We are 35 minutes by ground minimum to a level 2, with up to 90 minute transports even in good weather so there has been talk about putting it on the ambulance, but that's at least a year away. I believe the local level 4 ED has it as well.
 
Our flight service uses it. To echo others, it's not very expensive and has shown promising results. Effective studies will need to be performed in the time to come though. Many other drugs out there were the shizz nit when they come out and today are falling out of favor.

Time will tell.
 
The Crash 2 trial in 2011 showed a significant but not dramatic reduction in all-cause mortality when tranexamic acid was administered to trauma patients. IIRC, the benefits were not time-dependent up to 2 hours post-injury, which means unless you have really long transports, there doesn't seem to be much reason for EMS to give it.

The drug has been actually been around for quite a while, and is used in certain surgeries with a high potential for blood loss, both IV and oral.

The results of the trial were promising, but for some reason I have a feeling it is a bit of a fad that will be in vogue for a while and then fade away.
 
I've been debating proposing the idea of a study of this drug to our medical director. She is all for trying new things and we are rural enough it might show some promising results... But we are still trying to deal with teh state to see how we might approach this issue
 
It's funny that this is coming up here right now since there's also a discussion on the Trauma List Serv regarding TXA administration. Apparently there's an upcoming study in Australia on prehospital TXA usage for acute traumatic hemorrhage.
 
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