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Tranexamic acid question

Karim Brohi karimbrohi at gmail.com
Tue Jan 20 19:18:55 GMT 2015


We've recently had this paper in Annals.  K

http://www.ncbi.nlm.nih.gov/pubmed/25412319



On Tue, Jan 20, 2015 at 7:12 PM, Bjorn, Pret <pbjorn at emhs.org> wrote:

> 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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