Hostname: page-component-848d4c4894-8bljj Total loading time: 0 Render date: 2024-06-22T01:52:30.067Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of Fluctuating Extreme Temperatures on Tranexamic Acid

Published online by Cambridge University Press:  02 May 2019

Carly Loner ,
Michael Estephan ,
Hillary Davis ,
Jeremy T. Cushman  and
Nicole M. Acquisto
Carly Loner*
Affiliation:
Department of Emergency Medicine, University of Rochester, Rochester, New YorkUSA
Michael Estephan
Affiliation:
University of Rochester School of Medicine and Dentistry, Rochester, New YorkUSA
Hillary Davis
Affiliation:
Department of Emergency Medicine, University of Rochester, Rochester, New YorkUSA
Jeremy T. Cushman
Affiliation:
Department of Emergency Medicine, University of Rochester, Rochester, New YorkUSA Department of Public Health Sciences, University of Rochester, Rochester, New YorkUSA
Nicole M. Acquisto
Affiliation:
Department of Emergency Medicine, University of Rochester, Rochester, New YorkUSA Department of Pharmacy, University of Rochester Medical Center, Rochester, New YorkUSA
*
Correspondence: Carly Loner, MD Department of Emergency Medicine University of Rochester Medical Center 601 Elmwood Avenue, Box 655 Rochester, New York 14642 USA E-mail: Carly_loner@urmc.rochester.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Tranexamic acid (TXA) is an antifibrinolytic agent shown to reduce morbidity and mortality in hemorrhagic shock. It has potential use in prehospital and wilderness medicine; however, in these environments, TXA is likely to be exposed to fluctuating and extreme temperatures. If TXA degrades under these conditions, this may reduce antifibrinolytic effects.

Problem:

This study sought to determine if repetitive temperature derangement causes degradation of TXA.

Methods:

Experimental samples underwent either seven days of freeze/thaw or heating cycles and then were analyzed via mass spectrometry for degradation of TXA. An internal standard was used for comparison between experimental samples and controls. These samples were compared to room temperature controls to determine if fluctuating extreme temperatures cause degradation of TXA.

Results:

The coefficient of variability of ratios of TXA to internal standard within each group (room temperature, freeze, and heated) was less than five percent. An independent t-test was performed on freeze/thaw versus control samples (t = 2.77; P = .17) and heated versus control samples (t = 2.77; P = .722) demonstrating no difference between the groups.

Conclusion:

These results suggest that TXA remains stable despite repeated exposure to extreme temperatures and does not significantly degrade. These findings support the stability of TXA and its use in extreme environments.

Keywords

extreme temperaturesprehospital medicinetranexamic acid
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 3 , June 2019 , pp. 340 - 342
Copyright
© World Association for Disaster and Emergency Medicine 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Blackbourne, LH, Czarnik, J, Mabry, R, et al. Decreasing killed in action and died of wounds rates in combat wounded. J Trauma. 2010;69(1):S1–4.CrossRefGoogle ScholarPubMed
Evans, JA, Van Wessem, KJ, McDougall, D, Lee, KA, Lyons, T, Balogh, ZJ. Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surgery. 2010;34(1):158–163.CrossRefGoogle ScholarPubMed
Mannucci, PM, Levi, M. Prevention and treatment of major blood loss. N Engl J Med. 2007;356(22):2301–2311.10.1056/NEJMra067742CrossRefGoogle ScholarPubMed
Nishida, T, Kinoshita, T, Yamakawa, K. Tranexamic acid and trauma-induced coagulopathy. J Intensive Care. 2017;5:5.CrossRefGoogle ScholarPubMed
Shakur, H, Roberts, I, Bautista, R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23–32.Google ScholarPubMed
Morrison, JJ, Dubose, JJ, Rasmussen, TE, Midwinter, MJ. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg. 2012;147(2):113–119.CrossRefGoogle ScholarPubMed
De Guzman, R, Polykratis, IA, Sondeen, JL, Darlington, DN, Cap, AP, Dubick, MA. Stability of tranexamic acid after 12-week storage at temperatures from -20 degrees C to 50 degrees C. Prehosp Emerg Care. 2013;17(3):394–400.CrossRefGoogle ScholarPubMed
WHO Model List of Essential Medications. 20th List (March 2017, Amended August 2017). http://apps.who.int/iris/bitstream/handle/10665/273826/EML-20-eng.pdf?ua=1. Accessed September 10, 2018.Google Scholar
Gayet-Ageron, A, Prieto-Merino, D, Ker, K, Shakur, H, Ageron, FX, Roberts, I. Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients. Lancet. 2018;391(10116):125–132.CrossRefGoogle ScholarPubMed
Armenian, P, Campagne, D, Stroh, G, et al. Hot and cold drugs: national park service medication stability at the extremes of temperature. Prehosp Emerg Care. 2017;21(3):378–385.CrossRefGoogle Scholar
Brown, LH, Krumperman, K, Fullager, CJ. Out-of-hospital medication storage temperatures: a review of the literature and directions for the future. Prehosp Emerg Care. 2004;8(2):200–206.Google ScholarPubMed
Szucs, P, Allegra, JR, Fields, LA, et al. Storage temperatures of medications on an air medical helicopter. Air Med J. 2000;19(1):19–21.CrossRefGoogle ScholarPubMed
Allegra, JR, Brennan, J, Lanier, V, Lavery, R, MacKenzie, B. Storage temperatures of out-of-hospital medications. Acad Emerg Med. 1999;6(11):1098–1103.10.1111/j.1553-2712.1999.tb00110.xCrossRefGoogle ScholarPubMed
Brown, LH, Bailey, LC, Medwick, T, Okeke, CC, Krumperman, K, Tran, CD. Medication storage temperatures on U.S. ambulances: a prospective multicenter observational study. Pharmopeial Forum. 2003;29(2):540–544.Google Scholar
Church, WH, Hu, SS, Henry, AJ. Thermal degradation of injectable epinephrine. Am J Emerg Med. 1994;12(3):306–309.CrossRefGoogle ScholarPubMed
Valenzuela, TD, Criss, EA, Hammargren, WM, et al. Thermal stability of prehospital medications. Ann Emerg Med. 1989;18(2):173–176.CrossRefGoogle ScholarPubMed
Beasley, H, Ng, P, Wheeler, A, Smith, WR, Mcintosh, SE. The impact of freeze-thaw cycles on epinephrine. Wild Environ Med. 2015;26(4):514–519.10.1016/j.wem.2015.04.001CrossRefGoogle ScholarPubMed
Tranexamic Acid Injection. United States Pharmacopeia-National Formulary. https://www.usp.org/. Accessed August 2018.Google Scholar