Mon22November0925AM 8

Tranexamic acid:

True / False

Causes a transient rise in blood pressure if injected too quickly Correct

In the CRASH-2 trial there was a 15% reduction in absolute mortality Correct

It has an anti-inflammatory action Correct

Is a synthetic analogue of the amino acid lysine Correct

Prevents plasmin formation Incorrect answer selected

Explanation

Tranexamic acid is an antifibrinolytic drug. It is a synthetic analogue of the amino acid lysine. It binds to plasminogen on its lysine binding sites, preventing plasmin formation, and also displaces plasminogen from thrombin. Additionally, it may improve platelet function and have anti-inflammatory effects (inhibits complement activation, monocytes, and neutrophils).

The CRASH-2 trial examined the use of tranexamic acid in trauma patients within 8 hours of admission who were at risk of haemorrhage or were bleeding. There was a significant reduction in absolute mortality (1.5%). Subgroup analysis attributed this to an effect on a reduction of blood loss.

The results have been extrapolated in many forms of elective surgery where significant blood loss is anticipated (orthopaedic, liver, neuro-, maxillofacial, and cardiac surgery). The use of tranexamic acid has long been incorporated into military trauma algorithms. There are concerns that the use of tranexamic acid during elective surgery in patients at risk of thromboembolism may increase this risk. The evidence for this is patchy and therefore a risk assessment of all patients should be undertaken before administration.

The dose is 1-1.5 g given by slow intravenous injection. If injected too quickly, it causes significant hypotension.

Reference:

CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376:23-32.

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Average score: 58.64%

Times answered: 236