Tranexamic acid (TXA) is a drug often used to arrest hemorrhage in trauma patients. While this drug may have some beneficial properties, there are some risks associated with it as well.
A clinical trial
has investigated the risk of thromboembolism or blood clots associated with the use of tranexamic acid in trauma patients.
Death from traumatic injury is the most common cause of death in young adults and children globally, and more common than death from malaria, tuberculosis, and HIV/AIDS combined. Trauma-induced hemorrhage is the most common cause of preventable death in the United States, accounting for approximately 30,000 deaths per year.
Tranexamic acid is a medication commonly used to prevent blood loss during surgeries in patients with severe traumatic bleeding. Its beneficial effects in traumatic hemorrhage have been well-researched in several clinical trials. However, limited clinical data are available on the risks of thromboembolism associated with tranexamic acid use.
In an effort to rectify this, the trial analyzed the effects of early intravenous 2- and 4-g bolus dosing of tranexamic acid compared to a placebo in patients with severe traumatic bleeding.
The trial included a secondary analysis of a previously conducted clinical trial. It explored the risk of thromboembolic events associated with tranexamic acid. Thromboembolic events occur when a blood clot forms inside a blood vessel and can block the flow of blood, causing serious health problems.
The clinical trial enrolled 149 trauma patients of which 99 received tranexamic acid while 50 received a placebo. The results of the clinical trial showed that 29 out of 99 patients experienced blood clots in the tranexamic acid group compared to 6 patients out of 50 in the control group.
The clinical study found that early intravenous 2- and 4-g bolus dosing of tranexamic acid significantly increased the risk of blood clots in patients with severe traumatic bleeding when compared to a placebo. Additionally, the clinical trial also indicated that there was a dose-dependent risk of blood clots in the patients receiving tranexamic acid which means that the risk of thromboembolism was higher with increased doses of the drug.
The results of this clinical study are important because they implicate tranexamic in increasing the risk of thromboembolic events in trauma patients hence, they highlight the value of screening these patients for the potential developing blood clots.
Despite the potential increased risk of thromboembolism with the use of TXA, the evidence in large multicenter clinical trials indicates improved survival in a general trauma population. This supports the notion that TXA should not be withheld, but thromboembolism screening should be considered for patients receiving a dose of at least 2-g TXA intravenously for traumatic hemorrhage.
The clinical trial found that the use of early intravenous 2- and 4-g bolus dosing of tranexamic acid increased the risk of thromboembolic events in patients with severe traumatic bleeding when compared to a placebo. However, it supports the use of tranexamic acid in trauma patients when combined with appropriate screening for thromboembolism.