An Awesome Primer On EBM For All Clinicians: “Journal Jam 18 The Evidence for TXA – Should Tranexamic Acid Be Routine Therapy in the Bleeding Patient?” From

In this post I link to the Emergency Medicine Cases’ podcast and show notes, “Journal Jam 18 The Evidence for TXA – Should Tranexamic Acid Be Routine Therapy in the Bleeding Patient?“*. The podcast and show notes are relevant to all medical decision-makers because, in addition to its relevance to emergency medicine physicians, it also functions as an introductory tutorial on how to evaluate a topic using evidence-based medicine. And therefore it is relevant to all clinicians. [Note the podcast is 1:25:00 long and is worth every minute. Note to myself and readers: Although the show notes are outstanding as always,  to use the resource as an introductory tutorial on evidence-based medicine you must listen to the entire podcast.]

*Helman, A. Morgenstern, J. Milne, K. Journal Jam 18 – The Evidence for TXA – Should Tranexamic Acid Be Routine For The Bleeding Patient. Emergency Medicine Cases. June, 2021. Accessed August 4, 2021.

I have not excerpted anything from the show notes because if I need to quickly review any topic in the notes I need to just go to the show notes.

I have, however, time-stamped the awesome summary of Evidence-Based Medicine* from the podcast because the summary covers many of the crucial concepts of EBM

*This link is to the results of my search on Emergency Medicine Cases on typing Journal Jam into the search box of the site. There are eleven pages of resources from the site, not just from Journal Jam, that are relevant to EBM. u

Time Stamps of the summary of the podcast and show notes.

  • 56:00-1:03:30
    • Why replication of studies is so important in evidence-based medicine
      • Possibilities of any single study, no matter how well done are
        • Bias
        • Mathematical Fluke
        • A “true finding”
  • 103:30-1:07:20
    • Discussion of CRASH-3
  • 1:07:20-1:10:20
    • Tranexamic Acid During Prehospital Transport in Patients at Risk for Hemorrhage After Injury: A Double-blind, Placebo-Controlled, Randomized Clinical Trial [PubMedAbstract]
    • ;Very important and nuanced discussion of the above trial
  • 1:10:20-1:13:25
    • The harms of TXA
      • In the HALT-IT trial for GI Bleed [90% upper], 12,009 patients
        • “There was no difference in all cause mortality, death due to bleeding, rebleeding, surgery, endoscopy, need for transfusion, or total blood products transfused between the TXA group and placebo group.”
        • “The only statistically significant difference was an increase in venous thromboembolic events from 0.4% to 0.8%.”
    • TXA interferes with D-Dimer assays. It causes false negatives. So it is quite possible that we are missing a fair amount of DVTs because you diagnose DVT is with D-Dimer
  • 1:13:25-1:16:25
    • Why subgroup analysis is problematic in changing practice
  • 1:16:28-
    • The mechanism of action of TXA and why it is important in how you interpret these trials.
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