Massive Transfusion Protocol with TXA

Abstract

“Reducing mortality is vitally important considering that trauma injuries are the number one cause of death among Americans aged 1-46 years”. Massive transfusion protocols (MTPs) grant physicians the ability to follow an algorithm during a massive hemorrhage which allows for rapid replacement of blood products. MTPs are implemented to provide consistent treatment during hemorrhage. Tranexamic acid (TXA) a hemostatic agent has been shown to decrease mortality rates in trauma patients. In addition to decreasing mortality, tranexamic acid is also a cost-effective intervention. “The most recent estimated cost of 1 unit of red blood cells is $210.74, and the charge to the patient receiving the transfusion is $343.63. In comparison, 1 gram of TXA supplied in a 10 mL vial is estimated to cost between $45 and $55”. Some potential side effects and adverse reactions of TXA include nausea, vomiting, and diarrhea. Contraindications include acquired defective color vision, hypersensitivity to TXA, and active intravascular clotting. A systematic review found that when tranexamic acid is administered within three hours of injury it reduces the risk of death by 10% and the risk of death due to bleeding by 15%. Researchers in the MATTERS study concluded that risk for thrombotic events related to TXA such as deep vein thrombosis and pulmonary thromboembolism were too small to assess.