Tranexamic acid: the next drug available for Polish paramedics
Paramedics in Poland mainly work in Emergency Medical Services without physicians on board. Currently, they can administer 47 drugs on their own and perform Advanced Life Support based on European Resuscitation Council Guidelines. After the revision of Health Ministry Decret that increased their permissions, which project appeared on 25.05.2022, paramedics will have the possibility of using tranexamic acid on their own in a prehospital environment.
Tranexamic acid (TXA) is an antifibrinolytic agent which inhibits or completely blocks massive hemorrhage after trauma.
Administration of TXA results in a statistically significant decrease of 28 or 30‑day mortality dependent on blood loss and decreases day-of-trauma mortality. Administration of TXA does not depend on blood transfusion rate, amount of infused blood units, or the number of surgical interventions.
It is proven, that administration of TXA within 1 hour after injury and less than 1 to 3 hours after injury reduces the mortality rate related to blood loss but administration after 3 hours increases patients’ mortality rate.
Administration of TXA to patients with traumatic brain injury and without external bleeding decreases 28 or 30‑day mortality but does not affect neurological outcome measured 6 months after injury.
European Resuscitation Council Guidelines 2021 recommend administration of 1,0 g TXA in 100 ml 0,9% NaCl in 10 minutes infusion, continued with 8 hours infusion of 1,0 g TXA in 500 ml 0,9% NaCl. In case of lack of intravenous access, intramuscular dosing of 0,5 g twice into non-injured muscles is possible.
There was no increased number of adverse effects, especially thromboembolic complications in patients, who received TXA within 3 hours after injury.
Including tranexamic acid into the list of paramedics’ drugs will let them practice prehospital medicine in line with the latest medical knowledge and international guidelines. It will probably result in better outcomes in patients with hemorrhage shock, traumatic brain injury, and perinatal hemorrhage after prehospital delivery.
Keywords: paramedics, tranexamic acid, prehospital trauma treatment.
© Farm Pol, 2022, 78(5): 277–282