Håkon Bakke«How should tranexamic acid be administrered in haemorrhagic shock»
OA article in Shock #txa #trauma #medicine #CriticalCare @blackflagmedical
How should tranexamic acid be administered in haemorrhagic... : Shock
aimed to investigate whether dividing an i.m. dose of TXA between two injection sites, and whether an increase in dose, would lead to serum concentrations comparable to those achieved by i.v. administration. Methods Norwegian landrace pigs (n = 29) from a course in haemostatic emergency surgery were given tranexamic acid 1 h after start of surgery. Blood samples were drawn at 0, 5,10, 15, 20, 25, 35, 45, 60 and 85 min. The samples were centrifuged and serum TXA concentrations quantified with liquid chromatography–tandem mass spectrometry (LC–MS/MS). The use of two injection sites was compared to distributing the dose on one injection site, and a dose of 15 mg/kg was compared to a dose of 30 mg/kg. All i.m. groups were compared to i.v. administration. Results The groups were in a similar degree of shock. Increasing the i.m. dose from the standard of 15 mg/kg to 30 mg/kg resulted in significantly higher serum concentrations of TXA, comparable to those achieved by i.v. administration. Distributing the i.m. dose on two injection sites did not affect drug-uptake, as shown by equal serum concentrations. Conclusions For i.m. administration of TXA, 30 mg/kg should be the standard dose. With a short delay, i.m. administration will provide equal serum concentrations as i.v. administration, above what is considered necessary to inhibit fibrinolysis. Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Shock Society....
Rob Flint, MD