Prehospital Military Medicine
Mark Archambault, DHSc, PA-C, DFAAPA
Medical literature demonstrates strong support for the early use of tranexamic acid (TXA) in trauma patients.1 The medication is inexpensive, has few contraindications and has been used to control hemorrhage in surgical cases for decades. The effectiveness of TXA to inhibit hyperfibrinolysis inspired the 2010 CRASH-2 trial, which concluded that TXA safely reduced bleeding trauma patients' mortality risk.2 The military quickly incorporated TXA use into its tactical combat casualty care (TCCC) guidelines,3 and multiple prehospital emergency medical services (EMS) systems throughout the world followed suit. This article conducts a review of medical literature to ascertain current TXA administration practices to control hemorrhage in prehospital trauma patients.
The author performed a literature search in PubMed, EBSCOhost, MEDLINE, and CINAHL databases using Medical Subject Heading (MeSH) search terms "Tranexamic acid" AND "Prehospital." Articles and abstracts were examined, and studies that did not specifically apply to our outcomes were eliminated. The studies used for this review were assessed to include TXA administration to control hemorrhage in trauma patients. A total of 354 articles were identified and screened, duplicates were removed, and 25 full-text articles were assessed for eligibility, after which seven were included that met the objectives for this review.
The author addressed three categories of outcomes in this review article. First were the safety and efficacy of TXA administration in the prehospital environment. One randomized control trial and two prospective observational studies were used to make a high-quality assessment for safety and a moderate evaluation for the effectiveness of TXA use in the prehospital environment. The second outcome assed the use of coagulopathy studies to determine the efficacy of TXA in the prehospital setting. As both studies were observational and employed a small number of subjects, the recommendation is of low quality. The studies associated with the third outcome evaluated the TXA pharmacokinetic properties against the prescribed dosing regimen; however, they were also observational design and are rated low-quality evidence.
The current use of TXA in the prehospital setting continues to advance despite the lack of high-quality literature that directly contributes to its use. The use of TXA continues to demonstrate a strong safety profile with rare manifestations of known adverse outcomes.
Schultz PM. Tranexamic Acid Use in the Prehospital Trauma Patient. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2021; 3(3).
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