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Effect of Fluctuating Extreme Temperatures on Tranexamic Acid

  • Carly Loner (a1), Michael Estephan (a2), Hillary Davis (a1), Jeremy T. Cushman (a1) (a3) and Nicole M. Acquisto (a1) (a4)...



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.


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


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.


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.


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.


Corresponding author

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:


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