17-Apr-2013 Source: CALSTAR
Sacramento based CALSTAR, the largest nonprofit air ambulance on the west coast, is the first air ambulance in the United States to introduce a new “clot stabilizing” treatment to its arsenal of medications. Tranexamic acid (TXA) could save hundreds of lives in California and thousands across the country, according to Dr. David Duncan, CALSTAR’s medical director.
According to Duncan, this old drug now has a new job—it has been shown to decrease the mortality of critically bleeding trauma patients by about 30 percent if given in the first hour. He predicts TXA will become widely used in the immediate future.
Duncan said CALSTAR flight nurses can administer the first dose of TXA when first arriving on a scene or while in transport. A second dose, given over an eight-hour period, may be initiated by CALSTAR nurses or by the receiving center. Because of the newness of the drug, CALSTAR flight crews carry enough medication to give to the receiving medical center.
In addition to being CALSTAR’s medical director, Dr. Duncan also is the medical director for CAL FIRE and is a widely recognized emergency room physician.
Dr. Duncan said he added TXA to CALSTAR’s list of medications after carefully reviewing several studies, including CRASH-2 (Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage). CRASH-2 was a very large prospective placebo controlled trial evaluating 20,211 adult trauma patients with (or at risk of) bleeding. “The findings demonstrated four-week mortality was significantly lower in the TXA group than in the placebo group,” he said. “This was particularly apparent when TXA was given to bleeding trauma patients in the first hour during which mortality was reduced by 32 percent. The ’MATTERS’ study performed by the military also was a significant influence as it was a large retrospective study of TXA treated patients which demonstrated similar results. It is noteworthy that no unexpected or serious adverse events were attributed to the administration of TXA in any of the studies.”
Dr. Duncan said TXA has been slow to come to the United States for several reasons. Because TXA is a generic and does not have the FDA indication for the treatment of trauma patients, Pfizer has not aggressively marketed the drug. Also, the U.S. did not participate in the clinical trials, and so has been slow to adopt it. He said the drug is widely used in London, other parts of England, Australia, Canada and is now being used in New York City. Oklahoma City plans on initiating TXA in its ambulances this year.
“TXA will improve the outcomes of our sickest trauma patients and we are very excited about it,” Dr. Duncan said. “CALSTAR is proud to be on the cutting edge of this new treatment.