Journal of Acute Care Surgery

"tranexamic acid"

Review Articles

Trauma, Basic

Tranexamic Acid in Trauma Management: A Review of Evidence: Namryeol Kim; J Acute Care Surg 2023;13(3):85-94. Published online November 23, 2023; DOI: https://doi.org/10.17479/jacs.2023.13.3.85

Abstract
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Hemorrhage is the leading cause of death in trauma patients and trauma induced coagulopathy (TIC) is a major contributor to bleeding mortality. TIC has a diverse pathophysiology triggered by injury and hypoperfusion, including platelet dysfunction, endotheliopathy, fibrinogen or thrombin abnormalities, and dysregulated fibrinolysis. Early fluid resuscitation, appropriate blood transfusion, and definitive control of bleeding are essential components of initial management for TIC. Additionally, tranexamic acid (TXA), an antifibrinolytic agent, has emerged as a potential adjunctive therapy following the 2010 landmark trial that demonstrated the benefit of early administration of TXA in reducing trauma patient mortality (CRASH-2). This review provides an analysis of the current literature on the use of TXA in trauma patients. It critically evaluates the evidence on the effect of TXA on TIC and other clinical outcomes, emphasizing the time-sensitive nature of TXA administration and the variation of its effect depending on the severity and location of injury. It also discusses the optimal dosage, timing, and safety of TXA, as well as the challenges and limitations of existing studies. Furthermore, it highlights the importance of individualized treatment approaches based on the fibrinolysis status of TIC and the value of goal-directed therapy guided by viscoelastic hemostatic assays for the appropriate use of TXA.

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Pharmacokinetics of Tranexamic Acid (TXA) Delivered by Expeditious Routes in a Swine Model of Polytrauma and Hemorrhagic Shock
Mallori Wilson, Sean Stuart, Brittany Lassiter, Timothy Parker, Clyde Martin, Robert Healy, Christopher Treager, Eric Sulava, Lorie Gower, Pravina Fernandez, Emily Friedrich
Prehospital Emergency Care.2024; 28(5): 680. CrossRef

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Critical care, Basic

Tranexamic Acid in Trauma Management: Chan Ik Park, Jae Hun Kim, Sung Jin Park, Seon Hee Kim; J Acute Care Surg 2015;5(2):47-51. Published online October 31, 2015; DOI: https://doi.org/10.17479/jacs.2015.5.2.47

Abstract
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Hemorrhage is the major cause of death in patients with severe trauma. The early coagulopathy that occurs in patients with severe trauma, known as acute traumatic coagulopathy (ATC), has a major effect on morbidity and mortality. About a quarter of all patients with severe injury are reported to have coagulopathy at the time of arrival to hospital. The important mechanism of ATC is hyperfibrinolysis by up-regulation of activated protein C. Therefore anti-fibrinolytics are needed to treat trauma patients with ATC. Tranexamic acid (TXA) is a common anti-fibrinolytic broadly used in clinical practice. TXA is a lysine analogue and binds to lysine-binding site on plasminogen, interfering with plasminogen binding to fibrin. By inactivating plasmin, TXA can prevent hyperfibrinolysis. Clinical randomization of an anti-fibrinolytic in significant hemorrhage-2 proved TXA effective for patients significantly bleeding from traumatic injuries, reducing mortality in bleeding trauma patients without increasing the risk of thrombosis. The results of this trial led many trauma centers to include TXA in their major hemorrhage protocols. Early use of TXA is the simplest and most effective treatment to improve patient outcomes in trauma patients with significant hemorrhage. Therefore use of TXA should be considered in patients with major trauma.

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Intra-operative Tranexamic Acid Administration Significantly Decreases Incidence of Postoperative Bleeding Without Increasing Venous Thromboembolism Risk After Laparoscopic Sleeve Gastrectomy: a Retrospective Cohort Study of Over 400 Patients
Naveed Hossain, Vasha Kaur, Mostafa Mahran, Abdul Quddus, Santanu Mukhopadhyay, Akshat Shah, Sanjay Agrawal
Obesity Surgery.2024; 34(2): 396. CrossRef
Suspected anaphylactic shock associated with administration of tranexamic acid in a dog
Jin-Young CHOI, Jung-Hyun KIM, Hyun-Jung HAN
Journal of Veterinary Medical Science.2019; 81(10): 1522. CrossRef