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Tranexamic acid question

Karim Brohi karimbrohi at gmail.com
Mon Jan 26 06:30:30 GMT 2015


Lance
We didn't look at this separately.  Certainly something to go back and look
at.
Karim

On Sun, Jan 25, 2015 at 6:06 PM, Stuke, Lance E. <lstuke at lsuhsc.edu> wrote:

> Karim -
>
> I noticed in your study that the patients were given TXA in both the
> prehospital and hospital settings. How many of the patients in your study
> were given TXA in the prehospital setting? Did you notice any survival
> benefit in the subset of patients given TXA prehospital? Thanks.
>
> Lance
>
> Lance Stuke, MD, MPH, FACS
> Associate Program Director
> LSU Department of Surgery
> Spirit of Charity Trauma Center
> New Orleans, LA
>
> ________________________________________
> From: trauma-list-bounces at trauma.org [trauma-list-bounces at trauma.org] on
> behalf of Timothy Hardcastle [Hardcastle at ukzn.ac.za]
> Sent: Wednesday, January 21, 2015 2:14 AM
> To: Trauma-List [TRAUMA.ORG]
> Subject: RE: Tranexamic acid question
>
> 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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