From the Guidelines
Tranexamic acid (TXA) paste is the preferred choice for stopping bleeding due to its efficacy in reducing mortality and morbidity, as demonstrated in the CRASH-2 trial 1. The use of TXA has been extensively studied, and its benefits in reducing bleeding-related mortality and morbidity are well-established. In contrast, there is limited evidence on the efficacy of Desmopressin (D-STAT) in stopping bleeding.
- TXA works by inhibiting plasminogen activation, preventing clot breakdown, and has been shown to reduce mortality due to bleeding by 9% in trauma patients 1.
- The CRASH-2 trial, a large randomized controlled trial, demonstrated that early administration of TXA reduces the risk of death due to bleeding, with a relative risk of 0.85 (95% CI 0.76 to 0.96; P = 0.0077) 1.
- In addition to its efficacy, TXA is also cost-effective, with an estimated incremental cost per life year gained of $48, $66, and $64 in Tanzania, India, and the UK, respectively 1.
- While D-STAT may be effective in certain situations, such as deeper wounds or when immediate hemostasis is critical, the evidence supporting its use is limited, and it is not recommended as a first-line treatment for stopping bleeding.
- It is essential to note that TXA should be administered as early as possible, within 3 hours of injury, to maximize its benefits, and that protocols for the management of bleeding patients should consider administration of the first dose of TXA at the pre-hospital site of injury 1.
From the Research
Efficacy of Tranexamic Acid (TXA) Paste
- TXA has been shown to reduce blood loss in a wide range of surgical procedures and improve survival rates in obstetric and trauma patients with severe bleeding 2, 3, 4.
- The topical application of TXA has been found to reduce bleeding and blood transfusion in surgical patients, with a reduction in blood loss by 29% 5.
- A retrospective cohort study of 542 patients found that topical application of TXA aided as a useful supportive tool to stop mild bleeding events, such as bloody oozing of an oral wound 6.
Comparison with Desmopressin (D-STAT)
- There is no direct comparison between TXA paste and Desmopressin (D-STAT) in the provided studies.
- However, the studies suggest that TXA is effective in reducing bleeding in various clinical contexts, including surgical and traumatic bleeding 2, 3, 4, 5, 6.
Safety and Adverse Effects
- TXA is generally well tolerated, with most adverse reactions considered mild or moderate 2.
- High doses of TXA have been associated with seizures and other adverse effects, increasing the cost of care 2, 3.
- The risk of thrombotic events with TXA is uncertain, with some studies suggesting no increased risk 4 and others suggesting a potential increased risk in certain clinical contexts 3.