Transemic acid TXA useage

[island emt]

I know there was some discussion recently about the use of TXA both in hospital and in the field.

Here is a notice my wife got from the hospital admin today:

Used for: Reduction of blood loss following total knee arthroplasty. Bleeding risk is high in the first 24 hours following total joint replacements, and can lead to adverse outcomes such as pain, hematoma formation/expansion, decreased ability to rehab, and in severe cases, the need for blood transfusions.

Patient Population: All patients undergoing knee replacements from Dr. XXXXXX will receive TXA. Patients who will not receive TXA include patients who have a history of thromboembolism, kidney or liver disease, previous warfarin use, or bleeding disorders.

Mechanism of Action: Inhibits fibrinolysis (breakdown of fibrin), leading to increased coagulation.

Administration: Given as 1000 mg IV (in 50 mL NS over 10 minutes) in the OR right before incision and right after closure of the surgical site.

Properties: Half-life approximately 3 hrs, with therapeutic levels lasting for ~ 4 hrs, and no appreciable amount of drug in the blood ~ 18 hrs after administration (normal renal function). It is cleared through the kidneys, so serum concentrations will last longer with renal dysfunction.

Adverse Effects: The most important adverse effect of TXA is thrombosis formation, due to increased coagulation. Patients should be monitored closely for DVT/PE in the post-op setting.

Other side effects seen with TXA include rash, indigestion, nausea, vomiting, and diarrhea.

DVT prophylaxis: All patients will begin DVT prophylaxis (enoxaparin) when clinically stable, usually12-24 hours post-op, when the risk of clots becomes higher than the risk of bleeding.

Monitoring: Nurses should accurately document blood loss from drains and any pain medications used, as well as any symptoms of VTE.

[Arctickat]

Thanks bud, I'm working on a protocol proposal for our area to have this added to our scope.

[mobey]

Thanks bud, I'm working on a protocol proposal for our area to have this added to our scope.

have you seen Ab's?

[Arctickat]

Not yet Mobes. I hear ya just got it a few months ago.

[mobey]

With OLMC – Patients 16 years of age or greater within 3 hours of injury and presenting at any point with HR greater than 110 bpm or systolic BP less than 90 mmHg

Dosage

Repeat

With OLMC - 1 g IV/IO dilute in 250 mL D5W or Normal Saline bag and infuse over 10 minutes

Do not repeat dose

EMS Contraindications

• Hypersensitivity to Tranexamic Acid
• Active thromboembolic disease ( pulmonary embolus, DVT or stroke)
• Unable to initiate bolus within 3 hrs of injury onset
• If unable to contact OLMC, do not administer to patients less than 16 years of age

Notes

• Administration of Tranexamic Acid should not delay transport; rapid transport to a trauma facility is still the highest priority.
• To infuse 250 mL over 10 minutes the drip rate is 4 gtts/sec using a 10 gtt set

[Arctickat]

Thanks!!

[HarryM]

We use it here but if we want to have it used we need to call for a Dr to come out and administer it. So that doesn't really help much here but hopefully it might be added to an ALS scope of practice in the near future.