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Role of Tranexamic Acid Before Burn Wound Excision

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Topical tranexamic acid (TXA) is used in conventional techniques for reducing bleeding during burn surgery. Read below to learn about the same.

Medically reviewed by

Dr. Shivpal Saini

Published At February 24, 2023
Reviewed AtJune 15, 2023

Introduction

Blood loss during surgical intervention for burns is challenging. It is especially noticeable in the head and neck region and cases like delayed burn debridement. Various techniques for hemostasis (to stop bleeding) during burn surgery have been described. These include chemical and non-chemical treatments, such as systemic therapy, topical use of thrombin, fibrin sealant (that seals blood vessels), the elevation of the affected part, and a tourniquet (tightening of affected part). Topical tranexamic acid, an additional adjuvant to control bleeding during burns surgery, is described in the article.

What Is Tranexamic Acid?

Tranexamic acid is a synthetic compound that resembles the naturally occurring amino acid lysine in structure. Lysine significantly contributes to collagen formation (the building substance of skin), which gives skin flexibility and strength. It has been accessible for over 20 years. In 1986, the US Food and Drug Administration (FDA) granted its initial approval for its short-term usage as an injectable to lessen or stop bleeding during the extraction of teeth in hemophiliacs (patients of hemophilia). Tranexamic acid is an antifibrinolytic that stops the conversion of plasminogen to plasmin. It is an important molecule that breaks down fibrin clots and other plasma proteins accomplished by inhibiting plasminogen activation. The typical and approved method of delivery is systemic through an intravenous injection. However, topical usage has become very common in other types of surgery.

What Is the Dosage for Tranexamic Acid?

Tranexamic acid is a blood clotting aid that doctors prescribe. It can lessen blood loss due to significant operations, injuries, and postpartum hemorrhage. Doctors may also prescribe it to women who are experiencing severe menstrual bleeding. Different concentrations are employed in various surgical specialties. It is discovered that a 0.1 % (5 mg/1 ml) solution is enough for burn surgery, while the literature describes utilizing up to 5% (50 mg/ml) concentrations in dental surgery for individuals with bleeding issues. In topical application, no adverse effects or interactions have been documented yet.

How to Use Tranexamic Acid in Burn Wounds?

The topical tranexamic solution is applied as a hemostatic agent in burn patients in selective cases of burn debridement and grafting in regions where epinephrine is ineffective or inappropriate. After debridement, a gauze dressing is put on the bleeding area for 5 to 10 minutes with a saturation of 500 mg/mL tranexamic acid diluted in 100 mL of 0.9 % saline.

What Are the Side Effects Associated With Tranexamic Acid?

Every drug has numerous side effects. A side effect is an undesired reaction that occurs at therapeutic doses. Side effects may be minor or severe, short-term or long-lasting. Not everyone who uses this medicine experiences adverse effects. The following are some typical side effects with systematic use of tranexamic acid-

  • The patient will feel pain, nausea, vomiting, and diarrhea in stomach discomfort.

  • Some patients may experience headaches or migraines.

  • Backaches.

  • Cases of sinus and nose problems are encountered after tranexamic acid administration. The patient may have a runny nose. In severe cases, the nose may get blocked or clogged.

  • Joint stiffness and cramping in the muscles

  • Anemia (when the total red blood cell or hemoglobin content decreases).

  • Patients may feel weakness, fatigue, and lethargy.

When Should Tranexamic Acid be Avoided?

In the following conditions, it should be avoided:

  • Abnormalities of blood clotting, such as thrombosis (blood clot).

  • Convulsions (seizures).

  • Kidney dysfunction.

  • Personal and family coagulopathy (blood disorder) history.

  • Stroke.

  • An ischemic (decreased blood supply) heart condition.

  • People who take birth control pills and have leukemia (blood cancer) or liver or renal disease (kidney disease) should avoid the use.

How Tranexamic Acid Reduces Mortality in Burn Patients?

Two reasons are responsible for reducing mortality in burn patients with the help of tranexamic acid.

  1. First, it prevents clot breakdown and improves coagulation, decreasing bleeding after an injury.

  2. TXA acts as an antifibrinolytic agent that inhibits plasmin. Plasmin has a pro-inflammatory effect, activating inflammatory cells like monocytes, neutrophils, platelets, endothelial cells, and cytokines (chemically toxic to cells). Tranexamic acid blocks the plasmin in the body. As a result, the pro-inflammatory cells will not be released, leading to reduced mortality in burn patients.

What Medications Show Interactions With Tranexamic Acid When Used Simultaneously?

Tranexamic acid may interact with any of the following substances:

  • Hormonal birth control (estrogen and progesterone).

  • Fibrinogen.

  • Tretinoin is used in the treatment of acne.

  • A person should talk to a doctor or pharmacist if patients are taking any of these medications. The reaction will also depend upon the individual’s predisposition and circumstances.

What Are the Cautions for Using Tranexamic Acid?

A doctor should be informed about allergies or existing medical conditions, medications, whether pregnant or lactating (giving breast milk to a child), or any other important relevant health information. These factors influence the effect of tranexamic acid medication.

  • Birth Control - Blood clot risk increases with hormonal birth control, such as birth control tablets. Tranexamic acid with a birth control pill increases the risk of blood clots.

  • Blood Clots - Tranexamic acid increases the risk of blood clot formation due to reduced blood flow to vital organs or the extremities. Patients with a history of clotting may be more susceptible to problems caused by blood clots, such as heart attack, stroke, or blood clot formation in a deep leg vein. A conversation with a doctor is essential to know how this medicine may impact health. If a person feels signs like sudden, severe leg pain and swelling, chest pain, trouble breathing, impaired vision, or speech difficulties, then it is advisable to consult a doctor immediately.

  • Vision Problem - Tranexamic acid if used regularly may result in vision changes. This may involve altered color perception, blurred vision, or a shift in the field of vision while taking this drug. Before beginning this medicine, a doctor may examine the eye or suggest an ophthalmology consult so that any vision changes may be noted after medication.

  • Pregnancy - This drug is contraindicated during pregnancy.

  • Breast-feeding - Only a small amount of tranexamic acid can enter breast milk. According to research, nursing mothers can take this medicine safely.

  • Children - It is unknown whether this medicine is safe and helpful in treating heavy menstrual flow in adolescent girls.

Conclusion

Burn wound conversion is a process through which superficial burns become deep burns that involve the partial and complete thickness of the skin. This conversion process often requires surgical intervention, which increases morbidity. Therefore, it is good to use therapeutic measures to stop wound progression and cell death in burn-injured tissue. Early excision and grafting in burn wounds to reduce infection and sepsis. However, patients typically need numerous blood transfusions because the condition is linked to severe blood loss. Using tranexamic acid preoperatively can considerably reduce the need for blood transfusions during severe burn surgery. In recent research, it has been proved that the use of tranexamic acid reduces wound conversion, blood loss, and cutaneous damage.

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Dr. Shivpal Saini
Dr. Shivpal Saini

General Surgery

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