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Tranexamic acid question

McSwain, Norman E nmcswai at tulane.edu
Tue Jan 20 19:15:59 GMT 2015


All correct but not enough difference to make it worthwhile to use it

Norman

Norman McSwain, Jr. MD, FACS, NREMT-P
Professor, Tulane School of Medicine
Trauma Director, Spirit of Chairty Trauma Center. ILH
Police Surgeon, New Orleans Police Department
Medical Director PreHospital Trauma Life Support


-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
Sent: Tuesday, January 20, 2015 1:12 PM
To: 'Trauma-List [TRAUMA.ORG]'
Subject: RE: Tranexamic acid question

Stockinger?

More excellent grist for the mill, but a retrospective review of combat casualties hardly wipes the slate clean.  Several layers of epidemiology notwithstanding, this was 1400 patients to CRASH-2's 20,000; and just over 400 -- with significantly higher ISS -- received TXA at all.

>From what I read in the abstract, the authors (who open with credit to both CRASH and MATTERS) conclude at most that further study is indicated.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E
Sent: Tuesday, January 20, 2015 1:32 PM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: Tranexamic acid question

After EAST is seems that the spread is equal

Norman

Norman McSwain, Jr. MD, FACS, NREMT-P
Professor, Tulane School of Medicine
Trauma Director, Spirit of Chairty Trauma Center. ILH Police Surgeon, New Orleans Police Department Medical Director PreHospital Trauma Life Support


-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
Sent: Tuesday, January 20, 2015 10:56 AM
To: 'Trauma-List [TRAUMA.ORG]'
Subject: RE: Tranexamic acid question

Respectfully, Dr. Mattox, you and I made this bet about a year and a half ago.  So you have three and a half left.   Tick, tick, tick...

Thus far the line seems to be favoring TXA, and I'll take the spread.  It's no magic bullet, but it does seem to have a significant (if poorly isolated) effect on mortality, matched with risk index and price point close to that of vitamin C.  If those characteristics hold, I don't see it going away any time soon.  If anything, the use is lately expanding, which will inevitably answer some of our population-based questions -- to which I say, bring it on, either way.

(While we're at it, I further predict that the therapeutic pathway will surprise a lot of us and end up being only partly related to fibrinolysis, if at all.  Plenty of folks smarter than me suspect there's some helpful immune modulation going on in there...)

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
Sent: Tuesday, January 20, 2015 10:56 AM
To: trauma-list at trauma.org
Subject: Re: Tranexamic acid question

This drug, like its predecessors in its class (Aprotinen, etc.) has been a drug in search of an indication all of my professional  career.

The TXA studies have been hard to interpret and make a good  conclusion
from.   There have been some problems.

As a result, and because of its low cost, many ERs, EMS, and some surgeons have joined the band wagon.

I predict that within 5 years TXA will be used ONLY in patients who are
shown and demonstrated to have an ACTIVE  fibrinolysis problem.     Much of
the coagulopathy of  the past was over hydration.

BE CAREFUL  with putting it routinely in the ambulance, helicopter or  the
emergency  room.    NO, Be Very Careful not to  drink the cool aid.

k


In a message dated 1/20/2015 9:51:37 A.M. Central Standard Time, jduchesn at tulane.edu writes:

Agree  with Dr Mattox.
Duchesne

On 1/20/15 7:19 AM, "Kenneth Mattox"  <kmattox at aol.com> wrote:

>Be careful.   Not all as  it seems.
>
>Sent from my iPhone
>
>> On Jan 20,  2015, at 7:07 AM, Sori, Dr. Alan <sori at sjhmc.org> wrote:
>>
>> Hello everyone,
>>
>> Our Emergency Department  along with EMS is considering instituting a 
>> protocol where  tranexamic acid would be used in the field for 
>> patients with  suspected massive hemorrhage. Are other EMS systems 
>> using TXA and  under what circumstances. If you are, would you be 
>> open to sharing  your protocol with me?
>>
>>
>>
>> Thanks
>>
>> Alan Sori, MD
>>
>> Director SICU,
>>
>> Saint Josephs Regional  Medical Center
>>
>> Paterson, NJ
>>
>>  sori at sjhmc.org
>>
>>
>>
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