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TXA in the Urgent Care

Matthieu DeClerck, MD and Nick Saade, MD
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21:52

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Topical application of tranexamic acid to the bleeding surface has the potential to inhibit local fibrinolysis at the site of bleeding, reducing bleeding with minimal systemic effects.

 

Pearls:

  • TXA is a cheap and effective treatment for bleeding and has multiple applications in the urgent care setting.

  • The use of TXA in the UC setting is off-label and is not supported by any large randomized control trials.

 

WHAT IS TXA?

  • Tranexamic acid (TXA), is a synthetic derivative of the amino acid lysine.  It works by inhibiting the conversion of plasminogen to plasmin, thereby preventing clot breakdown.

  • Shakur H, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23-32. [PMID 20554319]

    • The CRASH-2 study showed a modest but clinically significant improvement in mortality in patients who had traumatic hemorrhage and received TXA.

  • TXA is commonly used in the setting of trauma for patients with massively internal hemorrhage to decrease bleeding.

 

POTENTIAL APPLICATIONS

  • Dental bleeding

    • TXA has been used to control bleeding for decades and is well-described in the dental literature.

    • TXA can be applied to gauze and placed in the mouth on sites that are actively bleeding.

    • Alternatively, you can make a TXA mouthwash by dissolving a 500 mg pill of TXA in 10 ccs of water and soaking the affected area  for 5 minutes.

  • Epistaxis

    • Soak pledgets or nasal packing in TXA prior to insertion in the nose to achieve maximum hemostasis.

    • Zahed R, et al. A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial. Am J Emerg Med. 2013;31(9):1389-92. [PMID 23911102]

      • This single center study of 200 patients who presented to the ED with epistaxis found that nasal packing with TXA was superior to packing with lidocaine in time to hemostasis, patient satisfaction and time to discharge.

    • Carter G, Goss AN, Lloyd J, Tocchetti R. Current concepts of the management of dental extractions for patients taking warfarin. Aust Dent J. 2003;48(2):89-96 [PMID 14649397]

      • TXA in the serum and saliva of patients who use the mouthwash are present in negligible levels making it safe for patients who are on therapeutic anticoagulation.

  • Lacerations

    • Apply TXA to gauze when applying point pressure to an actively bleeding wound.

 

SIDE EFFECTS

  • The side effect profile for topical TXA is extrapolated from information regarding the IV formulation.

  • Headache is a common side effect of the IV formulation.

  • Serious side effects include:

    • Hypersensitivity reactions

    • Anaphylaxis

    • Thromboembolism

  • Less common side effects include URI symptoms, abdominal pain, musculoskeletal pain, arthralgia, fatigue, nausea, vomiting and diarrhea.

Charles M. -

Black tea contains TXA,, so a "home remedy" for an oozing post-extraction dental problem is to pack the area with a tea bag. In the era before TXA was on the radar, I successfully used a tea bag pack to stop oozing dental bleeding. Not as sexy...but it does work...thanks to TXA.
Charlie Mead

Mike W., MD -

Thx for the info. I am hoping I never have a tooth pulled and never discover if a tea bag works!

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Alphabet Soup: TXA & IVDA Full episode audio for MD edition 210:46 min - 99 MB - M4AHippo Urgent Care RAP - January 2018 Summary 343 KB - PDF

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