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Tranexamic acid question

Jel Coward jel at wildmedic.org
Sun Jan 25 14:57:21 GMT 2015


Thanks Tim. I should have looked harder. Did someone also suggest some data
was presented somewhere suggesting no benefit from TXA?

cheers :)

Jel
On Jan 25, 2015 1:11 AM, "Timothy Hardcastle" <Hardcastle at ukzn.ac.za> wrote:

> Jel
>
> The paper that Karim posted showed a 4-fold increase in VTE in the
> treatment group, which due to absolute numbers was not hugely statistically
> significant,  but may still be of clinical importance for the patients who
> get these, when it prolongs hospitalisation or leads to mortality.
>
> Regards,
> Tim
> Dr Timothy Hardcastle
> MB,ChB(Stell); M.Med(Chir)(Stell); PhD, FCS(SA), Trauma Surgery(HPCSA)
> Head: UKZN Trauma Surgery Training Unit
> Deputy Director: IALCH Trauma Service and Trauma ICU
> Hardcastle at ukzn.ac.za / timothyhar at ialch.co.za
> Mobile +27824681615
> Postal: PostNet 27, Private Bag X05, MALVERN, 4055
> Durban, South Africa
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of Jel Coward
> Sent: 25 January 2015 00:53
> To: trauma-list at trauma.org
> Subject: Re: Tranexamic acid question
>
> Hi all
>
> Recently it was mentioned on this list some ?emerging evidence of no
> benefit with TXA and ? increased venous thrombotic events.
>
> Are there references for this please? (and if not, do we know where this
> work is coming from?)
>
> Thanks :)
>
> jel
>
>
>
> n 15-01-21 12:14 AM, Timothy Hardcastle wrote:
> > Karim
> >
> > Interesting study, prospective and civilian. My one concern is the VTE
> significantly higher in the TXA group, which has always been the concern
> I've had with this drug.
> >
> > Regards,
> > Tim
> > Dr Timothy Hardcastle
> > MB,ChB(Stell); M.Med(Chir)(Stell); PhD, FCS(SA), Trauma Surgery(HPCSA)
> > Head: UKZN Trauma Surgery Training Unit Deputy Director: IALCH Trauma
> > Service and Trauma ICU Hardcastle at ukzn.ac.za / timothyhar at ialch.co.za
> > Mobile +27824681615
> > Postal: PostNet 27, Private Bag X05, MALVERN, 4055 Durban, South
> > Africa
> >
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org] On Behalf Of Karim Brohi
> > Sent: 20 January 2015 21:19
> > To: Trauma-List [TRAUMA.ORG]
> > Subject: Re: Tranexamic acid question
> >
> > 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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