Shock. 2019 Jun 4;Epub ahead of print

# The Use of Tranexamic acid (TXA) for The Management of Haemorrhage In Trauma Patients In The Prehospital Environment: Literature Review and Descriptive Analysis of Principal Themes.

Stansfield R, Morris D, Jesulola E

Tranexamic acid (TXA) is an anti-fibrinolytic agent used to prevent traumatic exsanguination. It was first introduced to clinical practice for the management of patients with bleeding disorders, especially adapted to reduce bleeding in haemophiliacs undergoing oral surgical interventions. TXA exerts its action on the coagulation process by competitively inhibiting plasminogen activation, thereby reducing conversion of plasminogen into plasmin. This ultimately prevents fibrinolysis and reduces haemorrhage. Thus, TXA may be well suited for the management of traumatic haemorrhage in the pre-hospital setting.Despite multiplicity of studies on the use of TXA in clinical practice, there is no consensus regarding the use of TXA for the management of haemorrhage in trauma patients in the prehospital environment. Thus, a review on this topic was warranted. An extensive literature search yielded 14 full journal articles which met the inclusion criteria. These articles were thoroughly analysed and the and following themes were identified: "Dose of TXA administration", "Route of TXA administration", "Optimal window of TXA administration", "Safety of TXA use", "Clinical Effectiveness of TXA application" and the "Feasibility of TXA use in the prehospital setting".Overall, to achieve the best possible outcomes, literature supports the use of a loading dose of 1 gram of TXA, followed by 1 gram infusion over 8 hours, given by intravenous administration within a 3 hour window period of traumatic injury. TXA is very effective and safe to use in the pre-hospital setting, and its use is clinically and economically feasible.