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New way of delivering life-saving medicines will help front-line responders save the lives of trauma victims

 


TXA, a drug that prevents heavy bleeding after injury by preventing blood clotting from breaking down, is most effective when given immediately after injury. Every 15 minutes treatment delay reduces its life-saving potential by 10%. However, currently only 3% of trauma victims in the UK receive TXA within one hour of injury.

The drug is usually given by intravenous (IV) injection but providing an intravenous line may take time and the drug should be injected slowly.

This new research, led by the London School of Hygiene & Tropical Medicine (LSHTM) with partners including The Royal London Hospital and St George’s Hospital, shows that TXA can also be given by intramuscular (IM) injection, just like a flu shot , which requires less training and less time. They found that the drug was rapidly absorbed by the muscles and had no local side effects.

This means that TXA can be provided from early responses, greatly expanding access to emergency treatment. This can improve trauma care worldwide, especially in low- and middle-income countries where more deaths from trauma occur.

Dr Ian Roberts from LSHTM who led the study said: “An emergency injection of TXA is life-saving after serious injury, but patients are not being treated quickly enough. A rapid intramuscular injection given by first aid or paramedics can imply the difference between life and intramuscular TXA is like a vaccine against death from trauma. ”

Every year, about five million people worldwide die from injuries. More than 90% of trauma deaths occur in low- and middle-income countries, and up to 80% of deaths occur before arrival at the hospital. Tranexamic acid is the only proven life-saving treatment.

Previous work from a global collaboration led by LSHTM showed that TXA can reduce deaths in injury victims by up to a third provided it is given immediately.

In this study, 30 bleeding trauma patients admitted to two trauma hospitals in the UK were given the first dose of TXA intravenously, as directed, but the second dose by IM injection. The team then collected blood samples, monitored injection sites, and measured TXA concentrations.

The team found that intramuscular TXA is well tolerated only with mild and transient reactions at the injection site – some transient redness and swelling – nothing else. Importantly, TXA was rapidly absorbed by the muscles reaching the levels needed to save lives within 15 minutes even in the sickest patients.

Dr Ian Roberts said: “The fact that TXA can be given by intramuscular injection could be a game-changer to increase the survival chances of trauma victims. A simple automotive device that can be used by first responders or police officers. “Before the ambulance arrives – it can save thousands of lives every year. It can also be used by wounded soldiers either on their own or by a comrade.”

The research team is now working with the British Army on a motorist for use on the battlefield. The authors acknowledge that this will need proper field testing prior to approval.

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