Target Audience:

Who should attend:

• Clinical faculty from the University of Pittsburgh School of Pharmacy
• Clinical staff pharmacists employed by the University of Pittsburgh Medical Center and deployed throughout the hospital campus in unit based roles and centrally in the department of pharmacy's main pharmacy
• Student pharmacy interns currently working within the department of pharmacy
• Certified Pharmacy Technicians

Abstract:
Does Tranexamic acid administration reduce mortality in patients in trauma patients? Tranexamic acid works by preventing the breakdown of fibrin which intern helps the body stabilize hemodynamically during a bleed. The controversy around tranexamic acid comes about from the mechanism of TXA. The risk of using tranexamic acid in trauma patients is the possibility of putting someone at increased risk of clotting and thus developing a venous thromboembolism (VTE). The theory behind TXA use in this patient population is that administration of TXA after an acute injury reduces mortality from bleeding. Along with reduced mortality it had been suspected that TXA might reduce the amount of blood products a patient will receive. The benefits would include decreased mortality and less total blood products used.

In 2012 a study of over 20000 patients called CRASH-2 was published in the Lancet. This study concluded a strong recommendation to use TXA in a large population of trauma patients. This study is fraught with controversy and the argument continues to this day over TXA use in trauma. Recent literature points towards the idea that TXA may not have as strong of a recommendation as it was found to have in CRASH-2. Currently TXA is listed as a 1B recommendation in trauma patients with traumatic brain injury, as it has been shown to decrease mortality in this population. For the larger population of trauma patients, the conclusion is as follows: TXA administered within 3 hours of injury to patients not at risk for hypercoagulation may reduce risk of mortality from hemorrhage.

Educational Objectives:

Upon successful completion of this continuing pharmacy education program, the participant should be able to:

• Describe mechanism side effects and indications of tranexamic acid (TXA).
• Discuss literature surrounding TXA use in trauma-associated hemorrhage.
• Recognize clinical impact and utility TXA in patients with trauma-associated hemorrhage.

Pharmacy Continuing Education Credits In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. The assigned universal program number(s) is JA4008223-0000-23-080-H01-P. .  This knowledge-based activity provides 1  contact hours of continuing pharmacy education credit

Suggested Additional Reading & Joint Accreditation Statement:

Suggested Additional Reading

1. Freedman JE, Loscalzo J. Chapter 113. Arterial and Venous Thrombosis. In: Jameson J, Fauci AS, Kasper DL, et al, eds. Harrison’s Principles of Internal Medicine. 20e, New York, NY: McGraw-Hill; 2018.
2. CYKLOKAPRON® (Tranexamic Acid) Package insert. New York, NY: Pharmacia & Upjohn Co. 2013
3. A.P Cap, D.G Baer, J.A Orman, et al. Tranexamic acid for trauma patients: a critical review of the literature. Journal of Trauma. 2011;71(1):SS9-14
4. J. Eubanks. Antifibrinolytics in major orthopedic surgery. J Am Acad Orthop Surg. 2010;18(3):132-138
5. L.M. Napolitano, M.J. Cohen, B.A. Cotton, et al. Tranexamic acid in trauma: how should we use it?. Journ of Trauma and Acute Car Surg. 2013;74(6):121-126
6. E. Bose, M. Hravnak. Thromboelastography: A Practice summary for Nurse Practitioners Treating Hemorrhage. J Nurse Pract. 2015;11(7):702-709
7. Baker SP, O’Neill B, Haddon W, et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187-196
8. Development, Concepts and Doctrine Centre. Transfusion medicine leaflet 2-24-1: management of massive haemorrhage on operations. ln: Joint Service Publication 950: Medical Policy Part 2: Clinical Policy. Swindon, England: Development, Concepts and Doctrine Centre; 2009
9. Jawa RS, Singer A, McCormack Je, et al. Tranexamic acid use in United Sates trauma centers: a national survey. Am Surg. 2016;82:439-447
10. Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomized, placebo-controlled trial. Lancet. 2010; 376(9734):23-32
11. Morrison, JJ, Dubose JJ, Rasmussen TE, et al. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Jama Surg. 2012; 147(2):113-119
12. Luehr E, Grone G, Pathak M, et al. Administration of tranexamic acid in trauma patients under stricter inclusion criteria increase the treatment window for stabilization from 24 to 48 hours-a retrospective review. Int J Burns Trauma. 2017; 7(6):115-119

Joint Accreditation Statement
In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME) and the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

The University of Pittsburgh School of Medicine designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit[s]™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This knowledge-based activity provides 1.0 contact hours of continuing pharmacy education credit.

Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.