Tranexamic acid in remote damage control resuscitation

Authors

  • Joseph F. Rappold,

    Corresponding author
    1. Department of Defense Hemorrhage and Resuscitation Research and Development Program, Combat Casualty Care Research Program, United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
    • Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania
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  • Anthony E. Pusateri

    1. Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania
    2. Department of Defense Hemorrhage and Resuscitation Research and Development Program, Combat Casualty Care Research Program, United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
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  • The views and opinions expressed in this article are those of the authors and do not reflect the official policy or position of the US Air Force, US Army, US Navy, US Department of Defense, or the US Government.

Address reprint requests to: Joseph F. Rappold, MD, FACS, Division of Trauma and Critical Care, Department of Surgery, Temple University School of Medicine, Philadelphia, PA 19140; e-mail: joseph.rappold@tuhs.temple.edu

Abstract

With the advent of remote damage control resuscitation and far-forward surgery, a renewed emphasis has been placed on examining a variety of pharmacologic adjuncts to controlling blood loss before definitive operative intervention. In this paper, the authors review the current state of the art for tranexamic acid (TXA) and its potential benefits to those patients who are in need of a massive transfusion. Specifically addressed are its biologic and pharmacologic properties, as well the results of a number of recent studies. The 2010 CRASH-2 trial randomized in excess of 20,000 patients and demonstrated a reduction in all-cause mortality from 16.0 to 14.5% and death due to bleeding from 5.7 to 4.9%. The 2012 Military Application of Tranexamic Acid in Trauma Emergency Resuscitation study provided a retrospective analysis of 896 wounded cared for at a military hospital in Afghanistan. This study demonstrated a 23.9%-17.4% reduction in all-cause mortality. Finally, they discuss the potential complications associated with TXA use as well as areas of future research, which are needed to solidify our knowledge of TXA and its potential beneficial effects on controlling bleeding.

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