Inexpensive drug saves lives and trauma costs
Toronto, July 24, 2014
By Geoff Koehler
Dr. Alun Ackery
Giving trauma patients a $12 drug within three hours of their traumatic event could save lives, but not enough hospitals in Canada are using the drug. By the time a patient is referred to a trauma centre, the three-hour window has passed, making the drug less effective – which led St. Michael’s Hospital trauma doctors to publish a review article in CMAJ.
TXA, or tranexamic acid, is a drug that reduces blood loss by preventing blood clots from breaking down. Since the publication of a large multinational study in 2010, the drug is now being used for trauma and some operations such as hip- or knee-replacement. In these situations, TXA reduces the need for blood transfusions and saves hundreds of dollars per patient.
“The drug is standard care [for suitable trauma patients] at St. Michael’s Hospital and other major trauma centres,” said Dr. Alun Ackery, an emergency physician and trauma team leader at St. Michael’s. “But I don’t think that the many care providers who first see and treat trauma patients before they come to us know about this inexpensive drug and its life-saving effects.”
A large, international randomized control trial found that for every 67 trauma patients who are given TXA within three hours, one life will be saved. ORNGE, Ontario’s air ambulance service, has also begun using TXA for trauma cases but Dr. Ackery hopes to increase awareness among clinicians elsewhere.
“Uncontrolled bleeding causes 30 to 45 per cent of all trauma-related deaths,” said Dr. Ackery. “TXA seems to reduce the risk of bleeding out during trauma and seems to be most beneficial for patients with severe injuries or those receiving massive transfusions.”
Each dose of TXA costs about $6 and two doses are required for optimum care – the first given over 10 minutes and the second given over the course of eight hours. The total treatment cost of TXA is about $12, while the average cost of transfusing one unit of blood is $1,200.
“There are risks with any drug,” said Dr. Ackery. “Drugs that help blood clot, such as TXA, carry risks of pulmonary embolism, stroke or heart attack. But the harm from TXA appears to be minimal.”
Little increased risk of such events was shown for TXA in a large, multi-national study.
While there is significant evidence of the efficacy of TXA for trauma use in adults, Dr. Ackery said that evidence supporting the use of TXA for trauma in children is lacking. However he was part of a recent commentary in the jounrnal Critical Care, led by The Hospital for Sick Children (SickKids) in Toronto, which advocated for the use and further research of TXA for trauma in a pediatric setting – which SickKids has already adopted.
About St. Michael's Hospital
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.