From the Guidelines
Etamsylate and tranexamic acid should not be routinely administered together due to the lack of robust evidence supporting their combined safety and efficacy, and the potential increased risk of thrombosis. When considering the use of antifibrinolytic agents in trauma patients, the most recent and highest quality study 1 recommends that tranexamic acid be administered as soon as possible to the trauma patient who is bleeding or at risk of significant bleeding, at a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 hours. The use of tranexamic acid has been shown to reduce all-cause mortality and the risk of death due to bleeding in trauma patients 1. Some key points to consider when using tranexamic acid include:
- Administration should be as soon as possible, if feasible en route to the hospital, and within 3 hours after injury 1
- The standard adult dosing is 1g IV (or 10-15mg/kg) followed by additional doses as needed
- Careful monitoring for thromboembolic complications is essential, particularly in patients with risk factors such as history of thrombosis, pregnancy, or hormonal contraceptive use
- Tranexamic acid works by inhibiting fibrinolysis by blocking plasminogen activation In situations where enhanced hemostatic effect is needed, the use of etamsylate in combination with tranexamic acid may be considered, but this should be done with caution and careful monitoring due to the potential increased risk of thrombosis. Etamsylate improves platelet adhesion and capillary wall stability, and may be beneficial in situations like postpartum hemorrhage, trauma with significant bleeding, or perioperative bleeding management when single-agent therapy is insufficient. However, the combination of etamsylate and tranexamic acid is not routinely recommended and should be reserved for cases where the bleeding risk outweighs the potential thrombotic risk, and alternative hemostatic measures have proven inadequate.
From the Research
Ethamsylate and Tranexamic Acid Combination
- There is no direct evidence in the provided studies regarding the combination of Ethamsylate and Tranexamic Acid.
- However, it is mentioned in the study 2 that Ethamsylate can be an alternative in Tranexamic Acid sensitized patients, indicating that they can be used in similar contexts, but not necessarily together.
- The studies primarily focus on the use, efficacy, and safety of Tranexamic Acid in various clinical settings, including its potential risks and limitations 3, 4, 5, 6.
- Tranexamic Acid is shown to be effective in reducing blood loss and the need for transfusions, but its use must be carefully considered due to potential risks such as thrombotic events and seizures, particularly at high doses 3, 4.