title: Tranexamic Acid for Trauma Resuscitation in the United States of America.
abstract: The utilization of tranexamic acid (TXA) for the management of bleeding trauma patients has been a subject of much debate on both sides of the Atlantic and in Australia. As a result of the large randomized controlled study called theClinical Randomization of an Antifibrinolytic in Severe Hemorrhage (CRASH-2), there was an initial enthusiasm for the use of TXA to treat bleeding patients. However, the adoption of TXA in the United States was delayed by concerns of "knowledge and evidence gaps" of the CRASH-2 study and because of a lack of mechanistic rationale that would explain the survival benefit noted in the study. Subsequent nonrandomized controlled trials questioned the liberal use of TXA in trauma patients. This narrative review explores the historical as well as clinical and theoretical grounds for the more measured use of TXA in the United States and proposes a clinical and point-of-care guided utilization of TXA, blood components, and adjunctive hemostatic agents in bleeding trauma patients.
authors.affiliation: Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana.
authors.forename: Mark
authors.initials: M
authors.lastname: Walsh
authors.affiliation: Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana.
authors.forename: Scott
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Department of Surgery, Denver General Hospital, Denver, Colorado.
authors.forename: Ernest
authors.initials: E
authors.lastname: Moore
authors.affiliation: Department of Surgery, Denver General Hospital, Denver, Colorado.
authors.forename: Hunter
authors.initials: H
authors.lastname: Moore
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Andres
authors.initials: A
authors.lastname: Piscoya
authors.affiliation: Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hake
authors.affiliation: Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana.
authors.forename: Michael
authors.initials: M
authors.lastname: Son
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Tim
authors.initials: T
authors.lastname: Pohlman
authors.affiliation: Midwestern University, Glendale, Arizona.
authors.forename: Julie
authors.initials: J
authors.lastname: Wegner
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: John
authors.initials: J
authors.lastname: Bryant
authors.affiliation: Departments of Anesthesia, Emergency, and Critical Care Medicine, Ospedale dell'Angelo di Mestre, Venice, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Grassetto
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Patrick
authors.initials: P
authors.lastname: Davis
authors.affiliation: Division of Pulmonary Diseases, Critical Care and Environmental Medicine Tulane School of Medicine, New Orleans, Louisiana.
authors.forename: Nathan
authors.initials: N
authors.lastname: Nielsen
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Anton
authors.initials: A
authors.lastname: Crepinsek
authors.affiliation: Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana.
authors.forename: Jacob T
authors.initials: JT
authors.lastname: Shreve
authors.affiliation: W.M. Keck Center for Transgene Research, Notre Dame, Indiana.
authors.forename: Francis
authors.initials: F
authors.lastname: Castellino
mesh_terms: D006801:Humans; D014148:Tranexamic Acid / Q000627:therapeutic use*; D014481:United States; D014947:Wounds and Injuries / Q000188:drug therapy*
chemical_list: D014148:Tranexamic Acid