From the Guidelines
Tranexamic acid (TXA) paste is more effective than Surgical (fibrin sealant) for achieving hemostasis, particularly in cases of significant bleeding or coagulopathy, due to its mechanism of inhibiting fibrinolysis and stabilizing blood clots. The use of TXA has been extensively studied and recommended in various guidelines, including the European guideline for the management of bleeding and coagulopathy following major trauma 1. This guideline recommends the administration of TXA as early as possible to trauma patients who are bleeding or at risk of significant hemorrhage, with a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 h.
The efficacy of TXA in achieving hemostasis is supported by several studies, including the CRASH-2 trial, which demonstrated a significant reduction in all-cause mortality and death due to bleeding in trauma patients treated with TXA 1. In contrast, Surgical (fibrin sealant) is a topical hemostatic agent that creates a physical barrier over wounds, but its effectiveness is limited in cases of significant bleeding or coagulopathy.
Some of the key benefits of TXA include:
- Inhibition of fibrinolysis, allowing blood clots to form and remain stable at the bleeding site
- Ability to address the underlying clotting mechanism, making it particularly valuable for patients with coagulation disorders or those on anticoagulant medications
- Can be administered systemically or topically, depending on the clinical scenario
- Has been shown to be safe and effective in a wide range of clinical settings, including trauma, surgery, and obstetrics
In contrast, Surgical (fibrin sealant) is better suited for small, clean lacerations or external wound closure, but has limitations in cases of significant bleeding or coagulopathy. The use of TXA paste or other topical hemostatic agents, such as collagen-based or gelatine-based products, may be considered as adjuncts to traditional surgical techniques to obtain hemorrhagic control 1. However, the choice of hemostatic agent should be based on the specific clinical scenario and the underlying mechanism of bleeding.
Overall, TXA paste is the preferred choice for achieving hemostasis in cases of significant bleeding or coagulopathy, due to its mechanism of action and extensive clinical evidence supporting its efficacy and safety.
From the Research
Efficacy of Tranexamic Acid (TXA) Paste
- TXA has been shown to reduce surgical bleeding in various procedures, including cardiac, orthopedic, abdominal, and urologic surgery, cesarean section, and neurosurgery 2
- The efficacy of TXA varies according to the clinical context, timing of administration, and dose, with some reports finding that TXA reduces major bleeding by 25% without a significant increase in thrombotic events 2
- Topical application of TXA has been found to reduce bleeding and blood transfusion in surgical patients, with a reduction in blood loss of 29% and a relative reduction in the risk of receiving a blood transfusion of 45% 3
Comparison with Surgical (Fibrin Sealant)
- There is no direct comparison between TXA paste and Surgical (fibrin sealant) in the provided evidence
- However, TXA has been found to be effective in reducing bleeding and blood transfusion in surgical patients, which suggests that it may be a useful alternative to fibrin sealant in certain situations 3, 4
Safety and Side Effects
- TXA has been found to be safe and effective in reducing bleeding and blood transfusion in surgical patients, with minimal systemic effects when administered topically 3
- The risk of thromboembolic events with TXA is uncertain, but most studies have found no significant increase in thrombotic risk 2, 5, 3
- Adverse effects of TXA are few and mainly mild, with no evidence of an increase in the incidence of thrombotic events associated with its use 6