Tranexamic Acid in the ED

A quick case: A 57 y/o F with a PMH of DM, HTN, and Afib on warfarin presents to the emergency department (ED) complaining of spitting out a blood clot when she woke up in the morning. Upon waking she felt something in her mouth, spit out a small blood clot, and continued to have slow oral bleeding over the next several hours leading to presentation in the ED. She is not able to see where the blood is coming from, denies any other symptoms and states her last INR was 2.3. All other ROS is negative. On physical exam, it is noted that the patient has a broken upper left molar that is slowly bleeding. All other physical exam and vitals were normal. The attending physician suggested using tranexamic acid (TXA) for treatment. But what’s that? I didn’t learn about that in med school.

Clinical Question: What studied uses are there for tranexamic acid in the Emergency Department? [...]

tPA

While working on the Neurocritical care service, I have enjoyed seeing the teamwork between neurologists and emergency medicine physicians. Neurologists rely on the EM physician to inform them of potential stroke patients in the ED, while EM physicians use the neurologist as a guide in treatment management; however, in my short time on the service, I have seen a vast array of opinions on the administration of tPA. Tissue plasminogen activator or alteplase is a fantastic drug that saves lives when used in the right patient population. That is where the controversy lies. What is the right patient population and how do we avoid wasting valuable resources on non-stroke patients?