Use of Tranexamic Acid to Reduce Tissue Edema and Prevent Burn Wound Conversion
Abstract
Rationale/Objectives: This project addresses the burn wound conversion focus area. Burn injuries occur frequently in the military in both combat situations and non-combat situations. A typical combat burn injury may occur when a soldier is injured by a land mine, bomb, or other explosive device. Typical non-combat burn injuries are similar to those encountered in the civilian setting such as cooking oil fires, burning trash, structure fires, and vehicle crashes resulting in engine or fuel tank explosions. In the field, the options for treatment are limited to topical antibiotics, providing appropriate fluid to keep the patient from dehydrating, and expeditious transport to a burn care facility for further management. This has been the standard pre-hospital burn care for over 50 years. One important problem that has not been addressed is how to avoid conversion of shallow second-degree burn wounds to deeper wounds. This problem is labeled burn wound conversion and continues to pose a challenge to burn care providers as it leads to increased morbidity and the need for more extensive operations to achieve wound closure. The process by which burn wound conversion occurs is multifactorial, but poorly understood. Recently, multiple researchers have shown that prolonged inflammation, swelling in the injured skin, and blockage of blood vessels in the skin are critical factors in burn wound conversion. We have found in our preliminary research that the agent tranexamic acid (TXA) is able to reduce inflammation and swelling after burn injuries as well as protect damaged cells in animal and cell models. These characteristics predict that TXA may prevent burn wound conversion as well. In this project, we will investigate whether or not TXA is effective in reducing burn wound conversion. Furthermore, we will evaluate whether this agent can reduce the amount of tissue swelling after burns and the amount of pre-hospital fluid required to re-hydrate the burn-injured patient. This may confirm additional, more global benefit to the burn-injured warfighter, particularly in austere environments where prolonged (hours to days) pre-hospital treatment is often necessary. Applicability to military and civilian burn care: TXA is a therapeutic that is already incorporated into combat casualty care as standard of care in the treatment of hemorrhaging combat casualties. Therefore, the ability to use TXA to benefit burn casualties is logistically streamlined and nearly immediately able to be incorporated into field care if efficacy is proven. This is a distinct advantage over other potential treatment modalities being investigated for reduction of burn wound conversion. Non-medical and medical first responders are already familiar with and trained to use this agent in the field. TXA would have similar availability and use in the civilian setting as well. Importantly, the negative side effects of this agent are well understood after more than 60 years of use in the military and civilian trauma setting. Given these factors, we predict rapid adoption of this treatment in the military setting after a clinical trial, if efficacy can be proven in the animal model.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010474
Entities
People
- Damien Carter
Organizations
- MaineHealth
- United States Army