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Semin Thromb Hemost 2017; 43(2): 213-223
DOI: 10.1055/s-0036-1586226
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Tranexamic Acid for Trauma Resuscitation in the United States of America

Mark Walsh
1   Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana
2   Indiana University School of Medicine, Indianapolis, Indiana
,
Scott Thomas
1   Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana
,
Ernest Moore
3   Department of Surgery, Denver General Hospital, Denver, Colorado
,
Hunter Moore
3   Department of Surgery, Denver General Hospital, Denver, Colorado
,
Andres Piscoya
2   Indiana University School of Medicine, Indianapolis, Indiana
4   Division of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
,
Daniel Hake
1   Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana
,
Michael Son
1   Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana
,
Tim Pohlman
2   Indiana University School of Medicine, Indianapolis, Indiana
,
Julie Wegner
5   Midwestern University, Glendale, Arizona
,
John Bryant
2   Indiana University School of Medicine, Indianapolis, Indiana
,
Alberto Grassetto
6   Departments of Anesthesia, Emergency, and Critical Care Medicine, Ospedale dell'Angelo di Mestre, Venice, Italy
,
Patrick Davis
2   Indiana University School of Medicine, Indianapolis, Indiana
,
Nathan Nielsen
7   Division of Pulmonary Diseases, Critical Care and Environmental Medicine Tulane School of Medicine, New Orleans, Louisiana
,
Anton Crepinsek
2   Indiana University School of Medicine, Indianapolis, Indiana
,
Jacob T. Shreve
1   Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana
2   Indiana University School of Medicine, Indianapolis, Indiana
,
Francis Castellino
8   W.M. Keck Center for Transgene Research, Notre Dame, Indiana
› Author Affiliations
Further Information

Publication History

Publication Date:
01 December 2016 (online)

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Abstract

The utilization of tranexamic acid (TXA) for the management of bleeding trauma patients has been a subject of much debate on both sides of the Atlantic and in Australia. As a result of the large randomized controlled study called the Clinical Randomization of an Antifibrinolytic in Severe Hemorrhage (CRASH-2), there was an initial enthusiasm for the use of TXA to treat bleeding patients. However, the adoption of TXA in the United States was delayed by concerns of “knowledge and evidence gaps” of the CRASH-2 study and because of a lack of mechanistic rationale that would explain the survival benefit noted in the study. Subsequent nonrandomized controlled trials questioned the liberal use of TXA in trauma patients. This narrative review explores the historical as well as clinical and theoretical grounds for the more measured use of TXA in the United States and proposes a clinical and point-of-care guided utilization of TXA, blood components, and adjunctive hemostatic agents in bleeding trauma patients.

Keywords

tranexamic acid - fibrinolysis - CRASH-2 - fibrinolytic shutdown
 

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