Tranexamic Acid (TXA)
Indications for TXA are adult trauma patients within 180 minutes of injury with:
1. Severe hemorrhagic shock (SBP < 75 mm Hg) or
2. Known predictors of fibrinolysis (critical injury, massive hemorrhage, MTP) or
3. Fibrinolysis by TEG (LY30 > 3%)
Dose: 1g IV in 100cc NS over 10 minutes, then 1 g infusion over 8 hours
Tranexamic acid (TXA) is an antifibrinolytic that inhibits both plasminogen activation and plasmin activity, thus preventing clot break-down rather than promoting new clot formation. TXA has been used around the world to safely control bleeding since the 1960s. A large randomized trial recently conducted in >20,000 trauma patients (CRASH-2) adds to the large body of data documenting the usefulness of TXA in promoting hemostasis1. A recent review by Napolitano et al delineated clearly the appropriate criteria (above) for administration of TXA in trauma2.
1. CRASH-2 trial collaborators, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H, Gogichaishvili T, Gupta S, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376:23.
2. Napolitano LM, Cohen MJ, Cotton BA, Schreiber MA, Moore EE. Tranexamic acid in trauma: how should we use it? J Trauma Acute Care Surg 2013 Jun;74(6):1575-86.
