Controlling blood-loss is key when emergency responders on helicopters rush patients with traumatic injuries to the hospital.
That’s why University of Pittsburgh trauma experts are launching a trial to see if the blood-clotting drug, tranexamic acid (TXA) could save lives by helping medics gain control of internal bleeding.
“Traditionally what we’ve done is we’ve been able to stop hemorrhage on the outside with things like bandages and tourniquets and that type of thing,” Frank Guyette, medical director for STAT MedEvec, said. “But we really didn’t have any tools to stop hemorrhages on the inside except getting a patient quickly to a surgeon.”
He said because of that, they’d rush to get patients to the surgeon within the “golden hour.”
Uncontrolled bleeding can lead to multiple organ failure and infection and potentially death.
“If you’re bleeding internally, your body will try to clot blood and stop the bleeding to help protect you,” Guyette said. “And this drug doesn’t make the clot, but it stabilizes the clot, prevents it from breaking down and it improves your chances of controlling your bleeding, and it improves survival.”
Guyette said the medics will receive vials of medication – some will contain the TXA while others will have a placebo, but neither the medics nor the doctors will know which is which. He said the contents of the vials must be given to the patient within two hours of the injury.
The trial will be conducted under a federally-authorized exception from the informed consent process because patients who have traumatic injuries aren’t usually able to give consent to participation. But Guyette insisted that the study was designed with the patients’ safety in mind.
According to him, they’ve tried pro-clotting drugs before with serious complications, but TXA is unique in the fact that it does not create the clot, it just stabilizes clots that are already there, meaning it doesn’t have the dangerous side-effects.
Guyette said TXA has been used in dental and cardiac surgery, but until a recent set of studies, it was never used outside of a hospital.
He said the medics probably won’t begin administering the TXA until spring due to extensive preparation.
“They’re going to have to be trained on the characteristics of the drug, how to use the drug, how to administer the drug,” Guyette said. “And because this is a randomized study, they’re going to have to learn a little about the study procedure as well.”
Those who don’t want to participate in this trial can opt out by calling 412-864-1599 and obtaining a bracelet.