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Zehtabchi et al published a SRMA of TXA for traumatic brain injuries (TBI). However, better studies are needed to confirm these observations. Nebulized TXA shows promise for both post-tonsillectomy bleeding and hemoptysis. It is unclear if it provides a benefit for gastrointestinal bleeds (GIB).

REBEL EM has also looked at TXA for those conditions plus a few others.

Stroke due to Intracranial Hemorrhage – SGEM#236.

It seems to work for epistaxis, fails to cause a decrease in all-cause mortality in post-partum hemorrhage, does not demonstrate an improved neurologic outcome in hemorrhagic strokes but does have 1.5% absolute mortality reduction in adult trauma patients. The evidence for TXA providing a patient-oriented outcome (POO) has been mixed. You wonder if you should give tranexamic acid (TXA) while you wait for neurosurgery to call you back.īackground: TXA is a synthetic derivative of lysine that inhibits fibrinolysis and thus stabilizing clots that are formed. We have covered TXA as a treatment for bleeding a number of times on the SGEM. It demonstrates a traumatic intracranial hemorrhage. He is hemodynamically stable and sent for a STAT head CT. He arrives at the emergency department via EMS with a Glasgow Coma Scale (GCS) score of 10 and both pupils reactive.

He is also the creator and founder of REBEL EM and REBEL Cast, a free, critical appraisal blog and podcast that tries to cut down knowledge translation gaps of research to bedside clinical practice.Ĭase : A 42-year-old man falls off a backyard deck. Salim Rezaie currently works as a community emergency physician at Greater San Antonio Emergency Physicians (GSEP), where he is the director of clinical education. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial.