Tranexamic acid

for hyperpigmentation in addition to vitamin C. Niacinamide, it blocks melanin transfer to service skin cells and calms inflammation.

There's something called TXA, it's like tranexamic acid.

It targets and fades stubborn dark spots and post-inflammatory marks.

There's licorice root extract and rice extract, which are natural botanical brighteners that soothe and even out complexion.

We have to think about tourniquet.

We have to think about our resuscitation, TXA, make sure that we've got oxygenation and ventilation, making sure that we're not hypoxic or hypotensive with traumatic brain injury.

We know that's going to increase our mortality.

So it gives us a good framework with which to base our exam, our history, our approach in the truck, even simple things like warming the back of the truck and keeping our patient warm when we, you know, you may say DIC, that doesn't hit us in the truck.

We're, you know, listening and looking as far as breast sounds go, whether or not you're incorporating lung sliding into that.

It's probably going to depend on how old or young your trauma surgeon or emergency physician is.

TXA, it's worth talking about TXA here real quick.

If I was to design the trauma system, I firmly believe, and I think there are others out there, there's a lot of emergency medicine talk about TXA and whether or not it's all it's cracked up to be.

What is that? Which one? Yeah, it was the Mary Kay one.

Girl, the Tranexamic, the one that has the Tranexamic has the retinol, or which one? You should try the Synthia XW one.

I don't know what you guys are talking about

I'll plug you to a really really good one it reacted so

Good.

And what about the role of tranexamic acid or TXA in these patients? Is there any good evidence or specific population within the core of bleeding patients where it might be helpful?

So the CRASH-2 and 3 trials are definitely some good studies for determining whether TXAs are helpful.

For trauma patients with significant hemorrhage, the CRASH-2 trials, TXA reduced the all-cause mortality from 16% to 14.5%.

So definitely give your TXA in your trauma patients with hemorrhage.

For the traumatic brain injuries, the crash-through trials, there is benefits in mild to moderate TBI, but no benefit was demonstrated for severe TBI.

But if your patient came in with a significant multisystem trauma, TXA is always indicated.

So giving that TXA in the first hour or so definitely is indicated for those patients.

Most places use a threshold of 3% lysis as the upper limit of normal given the tenfold increase in hemorrhagic death associated with an LY30 greater than 3%, but consensus on the exact percentage is lacking.

CRASH-2 and MATTERS showed decreased mortality with TXA as an antifibrinolytic, but there are some concerns, particularly due to the increase in mortality and thromboembolic events, if TXA is given after 3 hours post-injury.

More selective use of TXA in only patients demonstrating fibrinolysis has gained increasing support.

And the other end of the fibrinolytic spectrum also carries increased mortality risk.

Often defined as LY30 less than 0.8%, fibrinolysis shutdown is seen in about 46% of severely injured patients in a large multicenter observational study.

This phenotype, while not associated with as high a mortality as hyperfibrinolysis, shutdown still remains an independent risk factor for mortality.

And given its high incidence, shutdown has also been used as an argument against routine use of TXA in a non-selective fashion.

But this topic is still controversial with ongoing debate regarding implications of shutdown such as overdiagnosis, differences between Teg and Rotem lysis values, and whether it actually represents a pathophysiologic phenomenon.

You're so right.

And I think azelaic acid leads us onto a good one because there is another ingredient that's very similar to azelaic acid and some of them, and they often get confused and that's tranexamic acid, also known as TXA.

So this is a synthetic derivative of the amino acid lysine, and it's a well-known drug for reducing bleeding.

It's really interesting.

I think a lot of these ingredients have come through medicine before they made it their way to skincare.

So it's actually used in medicine for heavy menstrual bleeding, and then it crossed over into skincare because doctors noticed the effect it had on pigmentation.

So what does TXA do? It fades dark spots and uneven tone, and it's used for melasma and for the marks left after acne scarring.

So how it works is it blocks plasmon, which stops a signal that UV light switches on in the skin and drives pigment production.

that.

When I have things that I'm going to prepare for the next case, like ANCEF or TXA, you'll actually see my big syringe with the thing like wrapped around it several times to make sure that I know what it is.

With the smaller ones that we have pre-made labels for, I find it to be much easier.

I also do that with things that I've adulterated the concentration that is atypical for whatever reason, just so I know what they are.

But I had never heard of it either.

and so I did a bit of research into it, and this is apparently the technique that they used here.

For highly neurotoxic medications like potassium or TXA, this procedure must be performed continuously for several hours.

Some case reports have over 22 hours, and the duration of the procedure is guided by the analysis of the CSF and how much of the contaminant remains, as well as the neurologic signs such as intracranial pressure if an EBD is in place, which of course means you have neurosurgery involved.

So having lysis in all three chambers and none on the last chamber usually means that we have a fibrinolysis as a process.

That, you know, if this was a trauma patient, I believe that most trauma surgeons would give TXA in response to this kind of result.

All right.

So I

Before we do that, I was just wondering if you can help to enlighten us about why some patients might go into this hyperfibrinolytic state.

Like what is causing it? Is it a clotting factor deficiency or is it something else?

Yeah, so I did mention that the pharmacologic intervention for this type of situation by trauma or in cardiac surgery is usually TXA.

And I do want to remind the listeners that TXA was tested in the setting of ICH.