Whenever people hear of a new, cutting edge drug that could save thousands or millions, many of them find it hard to believe. As the saying goes: If it sounds too good to be true, it probably is. However, this is not the case for a drug called tranexamic acid (TXA). In fact, it’s quite the opposite; TXA is so inexpensive that the public has no idea it exists.
What is Tranexamic Acid?
If you have heard of TXA, it has probably been in the context of menstrual bleeding. TXA is an antifibrinolytic, which people use to slow down the enzymatic breakdown of fibrin you find in blood clots. In simpler terms, it helps prevent blood clots from breaking down too quickly. This is especially handy when it comes to excessive or prolonged bleeding.[1,2]
Tranexamic acid is most often taken orally, with or without food and under the guidance of a medical professional. While some side effects do exist, most people who have used TXA report no or minor side effects. These may include:[1,2]
Muscle pain, spasms, or cramps
Stomach pain or nausea
Nasal or sinus congestion
Eye or eyelid problems
Tranexamic Acid and Other Amazing Uses
Outside of menstrual bleeding, TXA has been used in some incredible ways. According to emergency room physician and EMS director at St. Luke’s Hospital in New Bedford, Massachusetts, Dr. Matthew Bivens, “[TXA has] been proven on battlefields in Iraq and Afghanistan and showed positive results in huge randomized trials.”
In a 2013 randomized control study published in Health Technology Assessment titled CRASH-2, researchers studied the effects of TXA on 20,127 bleeding trauma patients from Europe, Africa, and Asia in 274 hospitals. What researchers found was astounding. If a bleeding trauma patient received TXA within 3 hours of injury, their risk of fatal hemorrhaging decreased by 30 percent. Incredibly, in over 20,000 participants (including pregnant women and children), there have been no reported side effects.
In Britain, paramedics’ ambulances have been equipped with TXA for years and it has made a significant difference. According to Bivens, a report called MATTERS found that out of 896 severely wounded British patients, TXA increased patients’ survival rates twice as much as those who did not get the drug. That’s a huge success!
So, Why Don’t More People Know About TXA?
Based on the stories and studies above, this is a question more for the United States than anyone else. If there was an effective drug that had been around since the 1950s that could slow bleeding, reduce the need for blood transfusions, and only cost $10, wouldn’t you want it in your hospitals and ambulances? It seems not.
Low-profit drugs such as TXA (at just ten dollars per dose) do not receive advertising budgets big enough to make it known. For Bivens, TXA’s minimal cost was the reason “why [they] had to pick it up and champion it. There was no marketing behind it. If it was a thousand-dollar drug we would’ve all heard about it.”
Bivens’ Push for Statewide Use of TXA
In February 2016, Bivens obtained a special project waiver from Massachusetts’ Department of Public Health for EMS departments in New Bedford, Fairhaven, and Acushnet, including a couple of private ambulance services. Since then, paramedics and doctors have used it for traumatic events ranging from shootings to stabbings to car accidents. Long-time local paramedics and EMTs are incredibly happy with the results, too:
“We’re giving it to major trauma patients. It clots blood faster so patients don’t bleed out. Basically, if their blood pressure is low and their heart rate is high and they’re in some sort of trauma, we’re using it.”
“TXA is a great thing because you can just mix it in an IV bag and let it run for 10 minutes. It’s kind of a set it and forget it type of thing. You don’t need to worry about internal bleeding as much and you can focus your attention on other areas as needed.”
A year and a half later, Bivens has requested that TXA be made available for statewide use – and it has been approved! In late July 2017, he met with Boston’s medical director and state director of the Office of Emergency Medical Services, Sophia Dyer and Mark Miller to discuss the best way to make this news known.
Bivens is still collecting data but according to his estimates so far, of the ~3,000 trauma deaths that occur annually in Massachusetts, TXA could potentially save up to 50 lives each year. So, “[for] a $10 drug with no side effects that nobody owns, that’s a pretty incredible number.”