Txa

[neoclassicaljazz]

Do any of you work for a department that uses TXA? Any opinions on it?

 

[MonkeyArrow]

Are you referring to tranexamic acid?

 

[neoclassicaljazz]

Yes.

 

[MonkeyArrow]

My department doesn't use it and I'm not aware of any departments, surrounding or otherwise, who do. However, like most "new"* concepts for the emergent control of bleeding, this concept is starting to gain pre-hopsital traction in the battlefield. Until it gains wide use and recognition by our military +10-25 years, we won't see it here in civilian EMS.

* New because although the drug has been around for decades now, its use and recent studies indicating its performance in the pre-hospital traumatic pt.

 

[STXmedic]

Rocketmedic carries it, and possibly transportjockey. Our flight service here just recently started carrying it, also. I've read the studies, but I'm still somewhat skeptical. The hype surrounding it is reminiscent of the wonder-drug Amiodarone.

 

[neoclassicaljazz]

I was just reading this article http://www.emsworld.com/news/11150967/ohio-agency-to-provide-txa-to-patients

I live in Ohio so I had heard about this a while ago.

Also a good radio show discussing TXA http://www.medflightradio.com/txa-changing-the-game-in-ems/

Just wondering if any other departments have had experience with this medication

 

[Merck]

We've carried it in our flight program for 3 years now with decent success (mostly anecdotal, with no evidence of harm). It is now being rolled out to our group ACP (Paramedic) crews. There is design to put it out to the PCP crews in the future if the initial introduction to ground is successful.

 

[Carlos Danger]

Rocketmedic carries it, and possibly transportjockey. Our flight service here just recently started carrying it, also. I've read the studies, but I'm still somewhat skeptical. The hype surrounding it is reminiscent of the wonder-drug Amiodarone.

Exactly. Looks great on paper, but I have a feeling that it'll end up another fad that didn't even come close to living up to the hype.

 

[TransportJockey]

Rocketmedic carries it, and possibly transportjockey. Our flight service here just recently started carrying it, also. I've read the studies, but I'm still somewhat skeptical. The hype surrounding it is reminiscent of the wonder-drug Amiodarone.

Not yet. We are getting it rather soon, along with Bumex, ketamine, and etomidate on our next update

 

[Medic Tim]

We are looking at it. It is in the provincial AHS protocols.

 

[the_negro_puppy]

It is carried and used by our trauma response team which is usually specially trained medics (RSI, FAST, Blood products) + or - a doctor.

I wrote a paper on it recently, here is an excerpt:

The CRASH-2 study in 2010 involved a randomised placebo controlled trial among trauma patients with, or at risk of, significant haemorrhage, of the effects of antifibrinolytic treatment (TXA) on death and transfusion requirement. The study found both a reduction in all-cause mortality and risk of death due to bleeding with administration of TXA versus the placebo [5]. In this study adult trauma patients were administered TXA within eight hours of injury in a hospital environment, with other studies involving TXA finding increased benefits when the drug is administered as soon as possible after a traumatic injury is sustained. Further analysis of the results of the major CRASH-2 study found that when TXA is given within the first hour of injury, the incidence of death by bleeding was reduced by 32% [6].

 

[rmabrey]

We dont have it, but transport times don't warrant it. A service one county north has it. I believe theyve uses it once in a year

 

[RocketMedic]

Carry it, used it once. It had no effect in the short term, and in the long term, I don't think it made a difference either. To me, it's just another block to check on the sheet in terms of short and mid-term effect, and I don't think it benefits ore than a tiny segment of the intended patient population.

Solid direct pressure and wound packing save more lives than TXA ever will.

 

[TransportJockey]

Carry it, used it once. It had no effect in the short term, and in the long term, I don't think it made a difference either. To me, it's just another block to check on the sheet in terms of short and mid-term effect, and I don't think it benefits ore than a tiny segment of the intended patient population.

Solid direct pressure and wound packing save more lives than TXA ever will.

I want to see that new clotting pellet syringe work more than this

 

[Handsome Robb]

Our flight crews carry it.

 

[MonkeyArrow]

I want to see that new clotting pellet syringe work more than this

Could you possibly be referring to the revmedx xstat syringe applicator. :unsure: I wonder if and when it will be available to the public as the 30mm is approved by the FDA and the 12mm is in the process.

 

[RocketMedic]

I too want and need that syringe. Also, the central-line occlusive stabbie-thing and abdominal wedge tourniquets and whole blood.

 

[Merck]

I think it is likely more than a fad - it's use has been commonplace in ORs for years. The idea of 'I used it and it didn't work' is not evidence. I believe when the number are crunched between CRASH-II and Matters, the NNTT is in the 70s. This seems high, but given that there is little adverse effect seen overall and that the cost is minimal, the decision to treat is reasonable. Don't expect miracle results, as people tend to want to see. Chances are, you're not saving a life. But you might be.

Oh and as an aside - if people put as much effort into making sure trauma patients weren't cold and didn't get 2 liters of N/S in 5 minutes, you'd probably see much more of an effect as anything else.

 

[LondonMedic]

CRASH II was 4 years ago and pretty convincing. We've had tranny acid on ambos and in routine use for two or three years now.

 

[Ensihoitaja]

I haven't done a ton of reading on tranexamic acid personally. Our chief trauma surgeon is vehemently against giving it indiscriminately, which makes me skeptical as well.

We don't carry it, but we are carrying plasma as part of the COMBAT study.