Blood coagulant during internal bleeding

[mycrofft]

Interesting study

The questions I would have for the authors would be if this was a study regarding open trauma clotting cases (incisions and the l,ike), and does "no evidence" of vascular occlusive problems mean it was studied and found lacking, or, since the focus was on trauma, if such instances were not considered. (Like when they, the folks who make Roux-en-Y hardware, studied Roux-en-Y gastric bypass and declared it safe by cutting off the post-surgical survival frame at eighteen months, when an expanded impartial study found that after eighteen months mortality continued and nearly doubled by three years' out).
EDIT: http://en.wikipedia.org/wiki/Tranexamic_acid
I feel stupid, I did not even think about maternal hemorrhage post-delivery, a very serious bleeding episode and which has been addressed with TXA and fundal massage; no study cited, but that is a big area of internal bleeding we in urban Western countries don't think about. It is OTC in Sweden and becoming so elsewhere, for menstrual bleeding, although it has been shown to cause thrombosis and necrosis of uterine fibroids.

 

[rexbanner]

Our province (Alberta) is seriously considering placing Tranexamic acid on car. While the new drug would take awhile to train and place on trucks provincally, it could definately be a life saver for some of these rural and remote incidents. Wonder how much it actually extends that golden hour...

 

[Commonsavage]

Tranexamic acid, although not a clotting agent per se, may see a role in the EMS environment sometime in the near future.

Which is what we use, here in my clinic, in Iraq, for GI bleeds.

 

[triemal04]

One of the clotting factors may eventually become a standard treatement option, though probably not in the field. There was a study that looked at either factor IV or VII (I blame a day of drinking for my memory lapse) as a treatement for acute intracerebral hemmorhage that had promising results until it was fully analyzed; last I heard it was being redone with a more selective entry criteria.

Of course, that was for a specific, localized injury, not massive or potentially massive bleeding.

 

[rexbanner]

So this protocol went live about 6 months ago. Acute hemorrhage control protocol. Includes Tourniquets, pelvic binding, and TXA.

I had the opportunity to give TXA last week and I would have to say it saved the patient’s life. Severe high speed MVC T-Bone to passenger side. Pt had prolonged extrication 20-30 minutes. Flat belly when initially removed progressing to extremely distended and firm abdomen. Pressure started to tank (below 60-70) and HR climbed. Classic hemorrhagic shock. Our protocol is to patch to OLMC for approval for administration of 1g of TXA IV over 10 minutes.

Patient was flown a short distance to a Trauma center.

I followed up a few days later expecting him to have succumbed to his injuries but it turns out he is alive. Torn abdominal aorta, torn iliac artery, fx femur, fx radial ulna. Abdominal and iliac arteries both clotted on their own. They didn't have to go in surgically to the aorta when he arrived. They were considering going in post stabilization to repair the tear but decided not to.

In my "non MD" opinion, this man was saved by the TXA.

TXA inhibits the activation of plasgminogen to plasmin.

 

[Merck]

We've been using TXA in BC at our Critical Care Paramedic level for scene responses and IFTs within the window for almost two years. Great anecdotal success.

 

[alabamatriathlete]

My big question is - even if you know, or suspect, there is bleeding internally, how do you know where the bleed is?

Civi-side, get them to ER/OR. Mil/tac-side, we're probably just going to chest-tube and attempt to stabilize until further care can be provided.

 

[jwk]

Aminocaproic acid has been used for years in cardiac surgery - it's not really a new drug, but the indications are expanding. It is an anti-fibrinolytic drug, essentially a "clot stabilizer" - it keeps clots from breaking down.

There is a synthetic Factor VIIa called NovoSeven. We use it on rare occasions for intractable hemorrage (along with FFP, platelets, and cryoprecipitate) usually caused by DIC. In my particular facility, due to our huge OB volume, we have a fair number of OB hemorrhage cases. This is one of the drugs of last resort. I doubt it finds it's way into pre-hospital use anytime soon, because the wholesale cost is on the order of $7,000 per dose.

 

[RustyShackleford]

As has been stated already we now use txa in Alberta, I haven't seen it used in the field so in regards to its efficacy I suppose time will tell.

 

[mycrofft]

So this protocol went live about 6 months ago. Acute hemorrhage control protocol. Includes Tourniquets, pelvic binding, and TXA.

I had the opportunity to give TXA last week and I would have to say it saved the patient’s life. Severe high speed MVC T-Bone to passenger side. Pt had prolonged extrication 20-30 minutes. Flat belly when initially removed progressing to extremely distended and firm abdomen. Pressure started to tank (below 60-70) and HR climbed. Classic hemorrhagic shock. Our protocol is to patch to OLMC for approval for administration of 1g of TXA IV over 10 minutes.

Patient was flown a short distance to a Trauma center.

I followed up a few days later expecting him to have succumbed to his injuries but it turns out he is alive. Torn abdominal aorta, torn iliac artery, fx femur, fx radial ulna. Abdominal and iliac arteries both clotted on their own. They didn't have to go in surgically to the aorta when he arrived. They were considering going in post stabilization to repair the tear but decided not to.

In my "non MD" opinion, this man was saved by the TXA.

TXA inhibits the activation of plasgminogen to plasmin.

Holy excremento. Yeah, the aorta will need something (an encasing stent or some such), but to monkey with it when it's apparently holding for now would be an operative misadventure.

Watch, someone will start messing up its use and it will get thumbed out for a while because it's gone from "mother's milk" to "dangerous".

 

[Veneficus]

In my "non MD" opinion, this man was saved by the TXA.

Knowing what I do, I disagree with your opinion.

I respectfully suggest you look up the mechanisms and treatment strategies of tears in large caliber arteries.

TXA may have helped, but certainly wasn't the deciding factor.

There is just too much in play for magic bullet remedies like this.

 

[mycrofft]

I respectfully suggest you look up the mechanisms and treatment strategies of tears in large caliber arteries

Got it, thanks or the PM as well.

 

[AUSEMT]

Paramedics in Israel can carry FFP, artificial plasma products and tranexamic acid

some flight paramedics in Australia (esp. Melbourne) can carry FFP & RBC's / O- neg transfusions/

 

[CANDawg]

FFP & other blood products are in the medic scope here, but they are much too precious to be carried on ambulances. Usually only seen on transfers, or administered by clinic paramedics. (The local helicopter EMS service might carry them though, not sure on that one.) TXA is on the books for possible inclusion on ambulances though, not sure of the status.

EDIT: Just saw someone else mentioned the same thing earlier. That's what I get for not reading the whole thread! :haha: