Adequate haemostasis after trauma and during surgical operation is a big challenge in modern medicine. About the 40% traumatic and more than 90% of combat deaths took place in pre-hospital settings. And about the 50% from these deaths have been reported due to massive blood loss (1,2). The US FDA first approved intravenous Tranexamic acid (TXA) in 1986 for short-term use as hemostatic agent. In 2009, FDA approved the Tranexamic acid (TXA) oral form (Tablets) for the treatment of menorrhagia. Tranexamic acid -4-(aminomethyl) cyclohexane-1-carboxylic acid- is a synthetic amino acid lysine derivative that competitively blocks the lysine binding sites on plasminogen (3,4).

Intravenous Tranexamic acid is commonly used in severely bleeding patients and number clinical trials were conducted. In 2010, CRASH-2 trial was a multi-center randomized, double-blinded, controlled trial where patients either received Tranexamic acid or placebo in adult trauma patients with significant hemorrhage, tranexamic acid reduced all-cause mortality at 4 weeks and the death rate due to bleeding in trauma patients (5,6). The MATTERs trial followed this in 2011 revealed TXA decreased overall mortality, notably those requiring massive transfusion protocols (7). The off-label intravenous uses of Tranexamic acid are seen in surgical operations to reduce blood loss. Surgical operations like total knee arthroplasty (8), orthognathic surgery (9), cardiac surgery (10) spinal surgeries, and transurethral retrograde prostatectomy (TURP,11).

Based on results of clinical studies, oral Tranexamic acid was also used to reduce blood loss in post-procedural after cervical conization (12) hereditary angioedema (13), transurethral retrograde prostatectomy (TURP) and tooth extractions in patients on oral anticoagulants (14). The research studies observed that Tranexamic acid is effective in reducing blood loss and transfusion without significant risks for increased mortality, stroke, myocardial infarction, or renal failure (15,16,17).

In this context, In the emergency and trauma setting, as bleeding control is an important part, we are planning to investigate the use of tranexamic acid spray.