One of the cheapest medical interventions to help stop bleeding – an $8 generic drug by the name of tranexamic acid (or TXA) – is rarely used by Canadian hospitals, even though it could save hundreds of trauma patients each year.
TXA has been sold for years over the counter in Britain to women with heavy menstrual bleeding and also in Japan to those with sore throats. It is believed to work by blocking plasmin, an enzyme that dissolves blood clots. The World Health Organization added it to its essential drugs list last year, and British and American armies have adopted it. Canada went a step further, deploying it with medics in the battlefield.
Ian Roberts, clinical trials director for the London School of Hygiene and Tropical Medicine and leader of a 2010 Crash-2 trial for TXA, has found that the drug could save an estimated 217 lives in Canada each year, if provided within three hours. And it can be done at a remarkably low cost: $8 per patient, or $12 if you throw in the tubing and IV needle required to infuse the drug.
Yet despite saving Canadian lives on the battlefield, the drug has been adopted slowly in Canada's emergency wards. Figures from IMS Health Brogan, a private company that tracks prescription drug spending, show sales of TXA to Canadian hospitals has actually dipped slightly, from $7-million in 2009 to $6.9-million in 2011.
"My impression is that most places are not using it," said Sandro Rizoli, president of the Trauma Association of Canada and general surgeon at Sunnybrook Health Sciences Centre, one of the few Canadian hospitals to use TXA. Sunnybrook has been quick to embrace the drug, with routine use of TXA with trauma patients increasing to 40 per cent in March, 2012, from 6 per cent in June, 2010. "There is a gap between knowing what to do and doing it – it's very well known in medicine."
Doctors say the slow overall uptake of TXA is typical. Empirical studies have shown that, on average, there is an eight- to 13-year wait, depending on specialist, between a treatment being proven to work and its adoption in everyday medical practice. And since low-cost generics such as TXA generate little profit, no drug companies are about to champion its use by spending millions to promote it.
"Most doctors get to know about new treatments because pharmaceutical companies promote them," Dr. Roberts said.
For those in the field where traumatic accidents occur, the benefits of widespread usage of TXA couldn't be clearer. John Tallon, past president of the Trauma Association of Canada and vice-president of medical programs at B.C.'s emergency and health services commission, says the drug should be carried by ground and air ambulance crews, noting the mean time for a patient to reach a trauma centre has been reported to be up to 6.7 hours in Ontario; 7.5 hours in Nova Scotia and 10.5 hours in Quebec. If given within three hours, TXA reduces the risk of bleeding in a trauma patient by 30 per cent.
"I'd love to tell you it's used from coast to coast to coast in an evidence-based way without exception," Dr. Tallon said. "But it's not true."