The efficacy and application of tranexamic acid in emergency medicine: Emergency Medicine Association of Türkiye clinical policy-2024
Gökhan Aksel1
, Şeref Kerem Çorbacıoğlu2, Mehmet Muzaffer İslam1, Alp Şener3,4, Fatma Nur Karaarslan5, Merve Osoydan Satıcı6, Enis Ademoğlu7, Resul Çinpolat8, Haldun Akoğlu9,10, Faruk Danış11,12, Fatma Sarı Doğan13, Emre Kudu14, Murtaza Kaya15, Emir Ünal14, Kamil Kayayurt10
1Department of Emergency Medicine, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Türkiye
2Department of Emergency Medicine, Atatürk Sanatoryum Training and Research Hospital, Ankara, Türkiye
3Department of Emergency Medicine, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Türkiye
4Department of Emergency Medicine, Ministry of Health Ankara Bilkent City Hospital, Ankara, Türkiye
5Department of Emergency Medicine, Manisa Soma State Hospital, Manisa, Türkiye
6Department of Emergency Medicine, University of Health Sciences Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Türkiye
7Department of Emergency Medicine, Gaziantep City Hospital, Gaziantep, Türkiye
8Department of Emergency Medicine, Tokat State Hospital, Tokat, Türkiye
9Department of Emergency Medicine, Marmara University School of Medicine, Istanbul, Türkiye
10Department of Medical Education, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Istanbul, Türkiye
11Department of Emergency Medicine, Bolu Abant İzzet Baysal University Medical School, Bolu, Türkiye
12Department of Emergency Medicine, Bolu İzzet Baysal Training and Research Hospital, Bolu, Türkiye
13Department of Emergency Medicine, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, İstanbul, Türkiye
14Department of Emergency Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Türkiye
15Department of Emergency Medicine, Kütahya Health Sciences University, Kütahya City Hospital, Kütahya, Türkiye
Keywords: Brain injury, emergency department, epistaxis, gastrointestinal bleeding, hemoptysis, intracranial hemorrhage, policy, tranexamic acid, trauma
Abstract
The clinical policy of the Emergency Medicine Association of Türkiye (EMAT) provides guidance on the use of tranexamic acid (TXA) in emergency settings. TXA, an antifibrinolytic drug, is used to control bleeding by inhibiting plasminogen. Its applications have expanded from hemophilia and severe menstrual bleeding to include various forms of trauma and surgery related bleeding. Despite its potential benefits, the use of TXA in emergency settings must be carefully evaluated due to its associated risks, including venous thromboembolism. This policy aimed to offer evidence based recommendations on the indications and contraindications of TXA in different clinical scenarios encountered in the emergency departments. The guidelines were developed using the “Grading of Recommendations, Assessment, Development, and Evaluations” approach, incorporating systematic literature reviews, and expert consensus from the EMAT Research Committee. This document focuses on critical clinical questions regarding the efficacy and safety of TXA in situations such as gastrointestinal bleeding, multitrauma, traumatic brain injury, nontraumatic intracranial hemorrhage, hemoptysis, and epistaxis. By addressing these issues, the policy seeks to assist emergency physicians in making informed decisions about the use of TXA, ultimately aiming to improve the patient outcomes.
How to cite this article: Aksel G, Çorbacıoğlu ŞK, İslam MM, Şener A, Karaarslan FN, Satıcı MO, et al. The efficacy and application of tranexamic acid in emergency medicine: Emergency Medicine Association of Türkiye clinical policy- 2024. Turk J Emerg Med 2024;24(4):185-205.
• Conceptualization – Ideas: GA (equal), ŞKÇ (equal), HA (support), and MMİ (support)
• Data curation: ŞKÇ (lead), GA (support), MMİ (support), EA (support), FNK (support), RÇ (support), and MOS (support)
• Formal analysis: GA (lead), AŞ (support), EA (support), KK (support), and MK (support)
• Funding acquisition: None
• Investigation: ŞKÇ (lead), GA (equal), HA (support), AŞ (support), FSD (support), EÜ (support), and EK (support)
• Methodology: GA (lead), ŞKÇ (equal), AŞ (support), HA (support), and AŞ (support)
• Project administration: ŞKÇ (equal) and GA (equal)
• Resources: GA (lead), FD (support), EA (support), RÇP (support), MOS (support), and FKA (support)
• Software: GA (lead), FD (support), EK (support), MMİ (support), and ŞKÇ (equal)
• Supervision: ŞKÇ (equal), GA (equal), AŞ (support), FSD (support), and MMİ (support)
• Validation: ŞKÇ (lead), MK (support), KK (support), EÜ (support), GA (support), and FNK (support)
• Visualization: GA(lead), ŞKÇ (equal), FD(support), FNK (support), MOS (support), EA (support), and EÜ (support)
• Writing – Original draft: GA (equal), ŞKÇ (equal), MMİ (support), FNK (support), RÇ (support), and AŞ (support)
• Writing –Review and editing: GA (lead), ŞKÇ (lead), FSD (support), MMİ (support), and AŞ (support).
None Declared.
None.
This clinical policy was prepared by the Research Committee of the Emergency Medicine Association of Türkiye (EMAT) for emergency physicians. We would like to express our gratitude to all EMAT board members and research committee members for their support and efforts.