TXA

[Gas]

Did a search for TXA use, and we all know of its benefits in trauma, total joints, postpartum hemorrhage just to name a few.

In terms of total joints, wanted to see what other places do - IV, PO, Topical? All have shown similar outcomes. Single dose, multiple doses? If IV, who gives it - us or the preop nurses just before entering the OR? And biggest question - contraindications. If we don't feel comfortable giving it (history of CAD stent, DVT, etc) does the surgeon give it topical or PO (preop of course)?

For us, not everyone is consistent, and just wondering what others do. Of note, our hospital has no interventional cardiac capability.

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[GassYous]

Give it iv at the beginning and the end. Some surgeons like only at the beginning, some put it in the joint directly. No real contraindications as far as I know, just don't put it in the spinal.

 

[Gas]

Give it iv at the beginning and the end. Some surgeons like only at the beginning, some put it in the joint directly. No real contraindications as far as I know, just don't put it in the spinal.

Thanks. When you say beginning and end, do you mean preop and PACU nurses? Or us, after patient sedated and again before waking up?

 

[GassYous]

In the OR
The nurses hook up the bag for us

 

[deleted875186]

Give in the OR, dose at the begining, dose after joint is in or tourniquet is down. Have to give it up front before bleeding, so early in postpartum hemorrhage or trauma, so really just dose at the beginning for these. If DVT or stent or something, I ask surgeon to give it topically, but honestly in an emergency I might still consider giving it, I think there’s just no safety data behind giving it given a patient history of DVT.

 

[nimbus]

If a patient is going to have GA, postinduction seems best since patients are less likely to seize after induction. I don’t see any benefit to giving it before giving our usual induction agents which have anticonvulsant effects.

 

[DocMcCoy]

If a patient is going to have GA, postinduction seems best since patients are less likely to seize after induction. I don’t see any benefit to giving it before giving our usual induction agents which have anticonvulsant effects.

Anybody seen a TXA induced seizure (non cardiac case)? Given this stuff a thousand times as has everyone in my group maybe we are just lucky. Any difference in treatment?

 

[repititionition]

Tranexamic acid-associated seizures: A meta-analysis - PubMed

The risk of seizure increased in patients with TXA exposure and the incidence rate of TXA-associated seizures increased when the dose levels increased.

pubmed.ncbi.nlm.nih.gov

The relative risk in this meta analysis is not low.

 

[2Fast2Des]

Never really saw the need to give a 2nd dose of TXA. Especially when the case is done before the half life is even halfway reached. Have a surgeon who does an anterior total hip, give TXA up front and then maybe 45 minutes to an hour in he asks for 2nd dose before starting to close.

 

[DocMcCoy]

Tranexamic acid-associated seizures: A meta-analysis - PubMed

The risk of seizure increased in patients with TXA exposure and the incidence rate of TXA-associated seizures increased when the dose levels increased.

pubmed.ncbi.nlm.nih.gov

The relative risk in this meta analysis is not low.

That’s all cardiac surgery getting a butt load of txa no? I get the risk is there especially with high dosing. Anecdotally, I haven’t seen 1 gram result in a seizure yet. Wonder if it’s subtle and happening on the floor or otherwise being missed.

 

[GassYous]

That’s all cardiac surgery getting a butt load of txa no? I get the risk is there especially with high dosing. Anecdotally, I haven’t seen 1 gram result in a seizure yet. Wonder if it’s subtle and happening on the floor or otherwise being missed.

I've given 2 grams at a time with no issues
Very safe drug as far as I can tell

 

[nimbus]

Anybody seen a TXA induced seizure (non cardiac case)? Given this stuff a thousand times as has everyone in my group maybe we are just lucky. Any difference in treatment?

No. Haven’t seen it in cardiac patients either but I’m not looking.

 

[repititionition]

Just sharing the paper. I hand bolus 1g TXA very frequently and have not yet seen any issues.

 

[epidural man]

Topical works as well as IV (from my understanding) with almost zero risk.

I don’t understand why things haven’t moved in that direction.