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Tranexamic acid and trauma

Russell L Gruen, Ian G Jacobs and Michael C Reade
Med J Aust 2014; 200 (5): 255. || doi: 10.5694/mja13.00023
Published online: 17 March 2014

In reply: We agree with Jarman and Brier that there is safety evidence for tranexamic acid (TxA) in elective surgery. We hypothesise that TxA’s effects in trauma are different. At least 1.5%–2% of trauma patients develop deep vein thrombosis (DVT) and pulmonary embolism (PE), and those who do average twice as long in hospital, are twice as likely to die, and face the long-term risks of anticoagulation and vena-caval filters.1,2 TxA impairs clot breakdown, so could cause excess PEs and DVTs in this higher-risk population, as seen in the MATTERs study.

  • Russell L Gruen1,2
  • Ian G Jacobs3,4
  • Michael C Reade5,6

  • 1 The Alfred Hospital and Monash University, Melbourne, VIC.
  • 2 National Trauma Research Institute, Melbourne, VIC.
  • 3 Emergency Medicine, University of Western Australia, Perth, WA.
  • 4 St John Ambulance (Western Australia), Perth, WA.
  • 5 Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, QLD.
  • 6 Joint Health Command, Australian Defence Force, Canberra, ACT.

Correspondence: R.Gruen@alfred.org.au

Acknowledgements: 

Russell Gruen is supported by a National Health and Medical Research Council Practitioner Fellowship.

Competing interests:

All three authors are chief investigators on the NHMRC-funded Prehospital Antifibrinolytics in Traumatic Coagulopathy and Haemorrhage (PATCH-Trauma) Study.

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