Tranexamic Acid

• Inhibits Fibrinolysis (Tissue injury stimulates clot formation, but at the same time to balance, stimulates plasminogen to form plasmin, plasmin then lyses the clot to Fibrin Degradation Products; Tranexamic is similar to lysine and competitively inhibits lysine area in plasminogen, so plasminogen won't convert to plasmin)
• 1g bolus, then infusion
• CRASH-2 TRIAL: 1g bolus IV, then 1g over 8 hours

1. Statistical improvement in mortality vs placebo
2. Rate of transfusion and surgery same
3. Thrombus formation is statistically not significant

Indication: Hemorrhagic Shock (hypotensive and tachycardic)

1. Adult

2. >60kg

3. Acute hemorrhage requiring transfusion

Exclusion:

1. Allergy

2. Seizure, SAH

3. Anticoagulant

4. Receiving treatment for DVT, PE or ACS

Administration

• 1g bolus, then 8-hour infusion
• omit infusion if crea >265 umol/L
• decrease infusion rate if BP drops
• Stop administration for seizures or SAH
• Nausea is common

Summary:

• inhibits fibrinolysis
• large RCT (CRASH-2) decreases mortality in hemorrhagic shock
• no increased risk of thrombosis
• cheap

More info: NNT is 125

NNT is mathematically defined as 1/(absolute effect size). In CRASH-2, the absolute effect size is the difference in bleeding rates between the treatment and control groups (5.7% - 4.9% = 0.8% = 0.008). 1/0.008 = 125. Thus the NNT is 125. You have to give tranexamic acid to 125 patients in order to save one bleeding death.

Source: HQMEDED.com (Dr Nathaniel Scott)