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September 16, 2013
Ohio medics believe new drug will save lives during longer EMS trips
The Columbus Dispatch
COLUMBUS, Ohio — An inexpensive drug gaining appreciation for its ability to slow bleeding in trauma patients has been used for the first time at the scene of a crash in Ohio.
On Saturday, Theresa Mitchell of Newark was riding her bicycle on an unfamiliar stretch of the Granville-Newark trail and ran into the wall of a tunnel. She broke her left wrist and shoulder and her right hand. Her fractured right femur broke through her skin.
When a squad arrived, EMS workers discovered a medically unstable patient who was bleeding from the leg and possibly suffering from internal bleeding. Fortunately, she’d been wearing a helmet.
Mitchell, 67, became the first patient to receive tranexamic acid, or TXA, under an agreement between the Newark Division of Fire and EMS and Ohio State University’s Wexner Medical Center, where many Newark trauma patients get care.
TXA is an interesting medical story. First, it’s cheap. The generic drug costs about $10 an intravenous dose. It’s used to minimize blood loss in planned surgeries and in those with hemophilia, to stanch oral bleeding in dentistry and to help women with heavy menstrual periods.
Although studies have shown the drug can save the lives of trauma patients and its use has begun to pick up inside trauma units, the use of TXA in the field (where it can do the most theoretical good in much of rural America) is still is in its infancy.
That’s certain to change, said Dr. Howard Mell, medical director for the Newark fire department. Recent studies have shown low risk and strong benefits, particularly in those with the most severe injuries.
A British-led study of more than 20,000 patients from 40 countries concluded that it cut the risk of death due to bleeding from 5.7 percent without TXA to 4.9 percent with the drug.
“If this was on patent (not generic), it would have already been mandated for use because pharmaceutical reps would have been marching on Capital Hill demanding its use,” Mell said.
Even after a small cut, the body first responds with a protein called fibrin, which slows bleeding before a blood clot forms, Mell said.
In major traumas, the body has too much to contend with and normal clotting fails.
TXA’s job is to extend the initial fibrin response until a patient can get into surgery, and it works best when given in the first hour, Mell said.
That’s why it makes the most sense for rural communities, he said.
Mell said he suspects others will follow and create protocols to use TXA at trauma scenes.
Agreements between first responders and trauma centers are essential because a second eight-hour dose of TXA has to follow the initial dose.
Elsewhere in the country, some first-responders have begun to use TXA.
Dr. David C. Evans, a trauma surgeon at Ohio State, said using TXA at trauma scenes makes sense in terms of timing and other practical matters. It doesn’t have to be refrigerated and has a relatively long shelf life.
While medics can control external bleeding with tourniquets, they have no way to stall internal bleeding, Evans said.
While life-threatening clots are a theoretical risk with TXA, studies so far have not shown a significant risk of harm compared to benefit, he said.
Mitchell, who is recovering at a rehabilitation center in Newark, didn’t end up bleeding internally. Still, she was grateful to have received the drug.
“I could have bled out. Who knows? I could have had internal bleeding. Who knows? I’m glad it was there and it was available.”
Copyright 2013 The Columbus Dispatch
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