Military approves Tranexamic acid for major hemorrhage

[Doczilla]

Is there a specific definition of 'massive' in the medical community Doc? Or is it an 'Oh shit...he's gonna need a ton of blood' call?

Not criticizing as I can't see a down side to this either. Or, is there a down side to using it on patients that won't require massive transfusions? Say, the medic that freaks out of a distal, isolated amputation.

Pretty cool find...

Dwayne

We generally define "massive transfusion" as needing 4 or more units of blood to correct hypotension or acidosis. We draw the line here with our current protocols, because this is when we will start giving FFP and platelets with the PRBCs to prevent coagulopathy.

We can predict need for massive transfusion if we give 2 units and the patient is still hypotensive. It is, to an extent, a judgment call in the early phase. Someone who is tachycardic and hypotensive at the outset (and doesn't have a tension pneumo or pericardial tamponade) is class 3 or 4 shock and has lost a liter and a half or more of blood. But I've seen a number of folks who are a little tachy but do fine after a couple of units of PRBCs and some Normosol and appropriate pain management. If the patient doesn't really respond to crystalloids at all, then they will not only need blood, but a lot of it.

I don't think we really know what would happen if we were giving this out like candy to patients. CRASH2 didn't see an increase in adverse events, but there was some selection bias with the study, large as it was. I don't foresee it being an issue if given through a line that will later receive blood, or in a different line while the patient is receiving blood. Would I push it through the same line that blood is currently running in? No, but I wouldn't push any drug through that line.

The Army has paid a lot of attention to the coagulopathy that presents with large scale hemorrhage and transfusion. We've played with different ratios of blood to FFP and platelets. In favor currently is the 1:1:1 ratio. There are trauma docs who now say not to give any crystalloid at all, and resuscitate only with blood products (whole blood if it is available). I think this is unrealistic in many prehospital settings, but I see their point overall.

The military is pushing it out at all surgical facilities, and is encouraging prehospital use among the more highly trained medics (SOF, primarily). Not sure if this will make it out to every 68W just yet.

The CRASH2 study did not find an increase in thrombotic events such as PE and DVT. Additionally, unlike Factor VII, there is actual evidence of benefit.

'zilla

[Asysin2leads]

Is there any studies about whether or not this increases the risk for DVT, pulmonary embolus, ischemic stroke, etc.?

[tniuqs]

Yup the CRASH2 study .... I believe a link was provided earlier and a you tube of Dr. Ian Roberts for ......

[tniuqs]

Is there any studies about whether or not this increases the risk for DVT, pulmonary embolus, ischemic stroke, etc.?

Yup the CRASH2 study .... I believe a link was provided earlier and a you tube of Dr. Ian Roberts for that.

Hey zilla .. what ever happened to Hypertonic Saline in TBI ? ... I know that one study was stopped in the poly trauma due to efficacy "not proven". I will say I was a bit sceptical from the onset as after doing ABGs and STAT lytes (up the ying yang) and sodium going it critical ranges with large doses of N/S alone and pitiful coags (making kool-aid but at least it didn't clot in the abg syringe, dark humour there.) so question is are there any other positive findings coming out of the sandbox in that reguard ? My reason for asking is my next deployment is kinda remote (no blood) and any advice appreciated.

https://secure.muhealth.org/~ed/students/articles/JAMA_291_p1350.pdf

[Asysin2leads]

Yup the CRASH2 study .... I believe a link was provided earlier and a you tube of Dr. Ian Roberts for that.

Hey zilla .. what ever happened to Hypertonic Saline in TBI ? ... I know that one study was stopped in the poly trauma due to efficacy "not proven". I will say I was a bit sceptical from the onset as after doing ABGs and STAT lytes (up the ying yang) and sodium going it critical ranges with large doses of N/S alone and pitiful coags (making kool-aid but at least it didn't clot in the abg syringe, dark humour there.) so question is are there any other positive findings coming out of the sandbox in that reguard ? My reason for asking is my next deployment is kinda remote (no blood) and any advice appreciated.

https://secure.muhea...A_291_p1350.pdf

Yeah I really should try reading the last line of articles sometime, lol.

[chbare]

The CRASH2 study did not find an increase in thrombotic events such as PE and DVT. Additionally, unlike Factor VII, there is actual evidence of benefit.

'zilla

True that. Will be interesting to see additional literature on this.