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Why use TXA? What is it, and how does it work?

Tranexamic Acid, or TXA is a drug that helps control hyperfibronolysis, which is associated with increased mortality. Essentially, the drug works to stop bleeding. TXA has been used in surgical suites for ages, but only recently are we seeing it move to the realm of EMS medicine. So how does it work, and when should we use it?

TXA is a synthetic lysine analogue that stops plasminogen from converting to plasmin. Specifically it does this by preventing the plasminogen from binding to the fibrin molecule. This stops the fibrin from cleaving, which leads to decreased bleeding. That’s a lot of science talk. Essentially, what happens is TXA stops the active part of the blood involved in hemorrhage from allowing hemorrhage to occur. TXA has a half-life of 2.3 hours, which becomes relevant when we discuss re-dosing. One big advantage to TXA is that there are no real contraindications to the drug. However, when a patient has reduced kidney function, it’s important to consider reducing the dose.

So why use it? 25-35% of patient with traumatic hemorrhage will display some kind of coagulopathy in the trauma bay. In general, EMS can help lower those numbers by giving TXA early. The biggest, and arguably most important study surrounding TXA was the CRASH-2 trial. CRASH-2 showed a decrease in overall and hemorrhage-induced mortality. The dose from CRASH-2 was 1g TXA over 10 minutes, followed by 1g over 8 hours. It is important to note the variables of CRASH-2, specifically that the patients observed were in developing countries.

TXA has shown to be an important and effective tool in the EMS arsenal when it comes to trauma resuscitation. When all the data is considered, it is a drug that should be available to all EMS systems, and should be available in all trauma resuscitation bays.

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