• Trauma, research
• thrombolysis
• research, clinical

Over the last 15 years, there has been an explosion in the use of tranexamic acid (TXA) in emergency and surgical care (with publications about TXA increasing from about 50 a year before 2010 to 340 in 2015). With rapidly changing evidence, it can be difficult for emergency physicians to judge both ‘who’ and ‘when’ to treat, but current use of TXA may be too late to be effective.

TXA is a rather weak antifibrinolytic that prevents the breakdown of clot. It was discovered in the 1950s by the remarkable Japanese husband and wife team of Shosuke and Utako Okamoto,1 however by the late 1990s, intravenous TXA was only occasionally used and there was just one manufacturer (forced to continued production under an ‘orphan drugs’ law).

Antifibrinolytics have long been used in cardiac surgery.2 A ‘coffee time’ conversation between an emergency physician and an anaesthetist, both of whom had recently been working in cardiac surgery, led to the question about the use of an antifibrinolytic in trauma. With the involvement of …