Novel Uses of Tranexamic Acid in the ED setting
This month JC is going to look at a few novel clinical applications of tranexamic acid or TXA in the ED setting. Interestingly, TXA has been around since the 1960’s when a Japanese research couple Shosuke and Utako Okamototo identified a drug that could prevent breakdown of fibrin clots by the enzyme plasmin with the intent of decreasing mortality rates from post-partum hemorrhage which at the time was a major cause of death. Their work has helped advance adoption of TXA as an adjunct in particular patient populations in the trauma setting (CRASH-2) and MATTERS, as well as CT surgery (ATACAS) and post-partum hemorrhage (WOMEN’s) trials. In many countries in Europe and Asia TXA is available OTC for heavy menstrual bleeding. I recall a conversation with one of our EVMS Attending colleagues from Denmark who laughingly said that Midol and TXA were a staple of every young female in her country. Clearly, TXA has not been widely adapted in most US ED’s however, does current evidence suggest that it should it be considered as a possible intervention in ED patients with complaints such as epistaxis, hemoptysis and dysfunctional uterine bleeding? Should make for an interesting discussion.
Zahed R et al, Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial. Acad Emerg Med. 2018 Mar;25(3):261-266. 9. Critical Appraisal