Hemostasis In Traumatic Hemorrhagic Shock. The Use Of TXA Michael M. Neeki , DO,MS, FACEP. RBC In Fibrin Mesh. Goal. Describe the three mechanisms involved in hemostasis
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
The Use Of TXA
Michael M. Neeki, DO,MS, FACEP
In the coagulation cascade, chemicals called clotting factors prompt reactions that activate still more coagulation factors. The process is complex, but is initiated along two basic pathways:
(6 RBC: 6 FFP: 6 platelet)
-Rivaroxaban and Dabigatran
- hypothermia and acidosis
- combination with TXA
* EACA (e-AminoCaproic acid
* TXA ( Tranexamic acid
* Aprotinin ( No marking since 2007)
that inhibits fibrinolysis by blocking the
lysine binding sites on plasminogen
• 10x more potent than Aminocaproicacid in vitro.
Intact fibrin clot
Fibrin clot exposed to plasmin
– Onset of action: 5-15 minutes
– Duration: 3 hours
• Distribution –
– Protein binding ~ 3%; primarily to Plasminogen
–Only a small fraction of the drug is metabolized (less than 5%).
– T1/2: 2-11 hours
• Excretion –
– Urine (>95% as unchanged drug)
10 minutes (loading dose)
– Followed by 1gm in 100cc/NSS over 8 hrs
• Can be mixed with just about any available solution
• Not to be administered in the same line as blood or
blood products or in a line used for rFVIIaor Penicillin
• Should be stored between 15-30C or 56-86F
• Active intravascular clotting
• Hypersensitivity to TXA
14.5% in the TXA (1463/10,060)
16% in the placebo (1613/10,067),P=0.0035
4.9% in TXA vs. 5.7% in Placebo
without an increase in fatal vascular occlusive events.
10% (RR0.91,95% CI 0.85-0.97)
15% (RR 0.85, 95% CI 0.76-0.96).
in combat casualties receiving at least 1u PRBC.
of which 293 received TXA
(17.4% vs. 23.9%; P=0.3)
• 129 Trials; 10488 patients;
reduced the probability of receiving a blood transfusionby a third
(risk ratio 0.62, 95% CI 0.59 to 0.65; P<0.001)
• Fewer deaths in TXA group
(0.61, 0.38 to 0.98; P=0.04)
– Statistical concerns about this group
• BOTTOM LINE – severe trauma - GIVE