Immediate Treatment With Tranexamic Acid Improves Survival Outcomes in Bleeding Patients

Highlights:

• Major bleeds can be fatal in the immediate period if not addressed immediately
• Tranexamic acid improves survival outcomes in patients suffering from post-trauma and postpartum bleeding, especially when administered early
• The survival benefits reduce by 10% with a delay of every 15 minutes, and are absent after three hours

Scientists suggest that tranexamic acid can reduce severe bleeding and save several lives of bleeding patients. The research was published in The Lancet. A severe acute episode of bleeding can be fatal if not controlled immediately. Bleeding may occur due to trauma like an accident or surgery, or due to a disease condition affecting the blood or an organ. While an external bleed is often treated urgently, an internal bleed like around the brain or in the digestive tract is difficult to detect early and can be more dangerous; the patient can collapse suddenly. Blood transfusions are administered to replace the lost blood; however, blood for transfusion is not always easy to obtain.

When a bleed occurs, the platelets in the blood first form a plug. The clot is then fortified by the activation of certain proteins in the blood called clotting factors to form a firm clot that stops the bleeding. The blood also contains a protein that is fibrinolytic i.e. that can break down the clot. Anti-fibrinolytic drugs like tranexamic acid, aminocaproic acid and aprotinin stabilize the clot. They have been used to reduce bleeding following surgery or following delivery. Tranexamic acid is available as tablets for the treatment of heavy menstrual bleeding in women.

Scientists studied the data obtained from two published clinical trials (CRASH-2 and WOMAN) to understand the survival benefits and the consequences of delaying treatment with anti-fibrinolytic drugs. Clinical trials assessed more than 40138 patients with acute severe bleeding due to trauma or following childbirth. The scientists found that

• Forty percent of deaths in the studies were due to bleeding. Around 63 percent of these deaths occurred within 12 hours of the onset of bleeding. In fact, deaths following childbirth most commonly occurred 2 to 3 hours after delivery.
• The administration of tranexamic acid increased survival following the bleeding. When the treatment was administered immediately after bleeding, the survival improved by 70%.
• The benefits of survival reduced when the treatment was delayed. Even a small delay reduced its effectiveness. The effectiveness reduced by 10% for a delay of every 15 minutes till 3 hours following the onset of bleeding. Beyond 3 hours, no benefit was noted.
• Tranexamic acid did not appear to be associated with significant serious adverse effects. It did not increase the chances of adverse events like heart attack, stroke, pulmonary embolism and deep vein thrombosis due to intravascular clot formation.

Thus, as noted from the study, it is important to start the treatment with tranexamic acid as soon as possible so that the patient can reap the maximum benefit of the treatment before tissue damage occurs. It should be readily available to patients at accident sites or in maternity wards. The results of other ongoing trials will hopefully throw more light on the benefits of this drug.

Reference:

1. Gayet-Ageron et al. Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients. The LancetDOI: http://dx.doi.org/10.1016/S0140-6736(17)32455-8

Source-Medindia