Txa

[RocketMedic]

I just don't know if it really matters.

 

[Christopher]

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.

It isn't fair to TXA to compare it to amiodarone. Amiodarone has no convincing evidence or large RCT's supporting its usage. TXA has both.

I'm not saying I'm sold on it as the wonder drug which cures all that ails our trauma patients...but at least it has evidence.

 

[Handsome Robb]

It isn't fair to TXA to compare it to amiodarone. Amiodarone has no convincing evidence or large RCT's supporting its usage. TXA has both.

I'm not saying I'm sold on it as the wonder drug which cures all that ails our trauma patients...but at least it has evidence.

Agreed.

I don't get it. We :censored::censored::censored::censored::censored: and moan that our treatments don't have any evidence to back them. Then we get a treatment that's backed by science and people :censored::censored::censored::censored::censored: about it saying that it's too good to be true.

"We need evidence!!"
"Here it is."
"Nope! You're wrong it doesn't work because I don't believe it."

:unsure:

 

[STXmedic]

Touché, Robby

 

[medicsb]

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.

NO ONE has said TXA is meant to replace direct pressure or wound packing (as if that were something frequently done in EMS).

How many times have you ever seen aspirin work?

The benefit is realized over time when used on a large number of patients for whom it is indicated. At a certain point, the NNT is too big to be able to conclusively identify patients who benefited.

 

[Tigger]

My place could certainly benefit from it given population and distance from trauma centers, though the flight services do carry it. I think our issue would be the pricepoint, a JEMS article stated (if I remember right) that the cost of one dose is around $40 dollars. Could we find 1000 dollars to put it on our ambulances and the supply closet? Sure, but given it's expected use rate I'm not sure they'd go for it, right or wrong as that may be.

 

[LondonMedic]

$40?

It's off patent. You can buy one dose of it in the UK, at full list price, for the equivalent of $5.20.

 

[Tigger]

Well if that's the case that sort of negates that issue. The article I was thinking of is a year old, guess that's outdated these days.

 

[Carlos Danger]

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.

It isn't fair to TXA to compare it to amiodarone. Amiodarone has no convincing evidence or large RCT's supporting its usage. TXA has both.

I'm not saying I'm sold on it as the wonder drug which cures all that ails our trauma patients...but at least it has evidence.

I never questioned the efficacy of tranexamic acid. I give it routinely and am quite familiar with it.

What is a fad is the hype surrounding it as the next "EMS wonder drug". I believe that will pass in a fairly short time. In that way, it is not unlike amiodarone was.

 

[STXmedic]

What is a fad is the hype surrounding it as the next "EMS wonder drug". I believe that will pass in a fairly short time. In that way, it is not unlike amiodarone was.

Exactly what I was getting at.

 

[Christopher]

I never questioned the efficacy of tranexamic acid. I give it routinely and am quite familiar with it.

What is a fad is the hype surrounding it as the next "EMS wonder drug". I believe that will pass in a fairly short time. In that way, it is not unlike amiodarone was.

Amiodarone was pushed without any good evidence as the next wonder drug to make money. Nobody makes money off TXA use expanding, hence the unfair comparison.

 

[Carlos Danger]

Amiodarone was pushed without any good evidence as the next wonder drug to make money. Nobody makes money off TXA use expanding, hence the unfair comparison.

Again, my comment was about the hype, not the efficacy or the research backing the drugs.

 

[the_negro_puppy]

We've had tranny acid on ambos and in routine use for two or three years now.

 

[Carlos Danger]

Enthusiasm for Prehospital Use of TXA May Be Premature

Exactly what I was saying two years ago. There were a lot of problems with the CRASH II trial.

 

[Aprz]

I feel like everything in EMS is always next the wonder thing, lol. We just can't stop ourselves.

 

[ERDoc]

I feel like everything in EMS is always next the wonder thing, lol. We just can't stop ourselves.

It's not just EMS, it is medicine as a whole, ie Amiodarone, Nesiritide, etc

 

[TXmed]

I give it at my flight service. We just sling it. It's better when given earlier rather than later. And don't just reserve it for the "bad" trauma patients.

 

[SpecialK]

The PATCH trial for pre-hospital TXA starts in Auckland tomorrow (9 May).

https://clinicaltrials.gov/ct2/show/NCT02187120