Tranexamic acid is a simple little molecule, just a synthetic derivative of the amino acid lysine. But it’s also a potent pro-hemostatic drug that binds plasminogen and plasmin and stops the degradation of fibrin (the stuff in blood clots).
Now there are two studies that have proven benefit for transexamic acid (TXA) in major trauma. The UK-based CRASH-2 trial showed that TXA saves lives after trauma. A new meta-analysis that analyzed over 10,000 patients also shows that TXA reduces transfusion requirements by 1/3 and showed a trend towards reduced mortality (risk ratio = 0.67, (0.43 to 1.09; P=0.11).
So tranexamic acid stops bleeding, reduces transfusion requirements, and saves lives in bleeding trauma patients. And unlike NovoSeven, it doesn’t cost $1,200,000 a gram (or about $10,000 per 8 mg dose, given every 2 hours). So why is almost no one in the U.S. prescribing tranexamic acid — for G.I. bleeding patients, intracranial hemorrhages, trauma, and surgical misadventures?
Tranexamic acid is also very inexpensive at $100 per gram in the U.S., and less in other countries.
Katharine Ker, Phil Edwards, Pablo Perel, Haleema Shakur, and Ian Roberts. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 2012; 344:e3054.
transexamic acid , surgical bleeding , trauma , HPC updates