Tranexamic Acid in Trauma

• Trauma is the leading cause of death in individuals up to 45 years old and the fourth leading cause

of death overall for all ages.1

• Uncontrolled hemorrhage is the leading cause of early mortality in major trauma.2
• Trauma-associated hemorrhagic death occurs as an effect of uncontrolled bleeding and trauma-

induced coagulopathy.3

• Tranexamic acid is an antifibrinolytic medication that works by forming a reversible complex that

displaces plasminogen from fibrin resulting in inhibition of fibrinolysis.4

• Tranexamic acid is readily available, simple to administer, relatively inexpensive, with minimal side

effects.

Tranexamic Acid

Dose

• Loading dose: 1 g over 10 minutes started within 3 hours of injury

o 2 gram via slow IV Push*

• Maintenance: 1 g over the next 8 hours as a continuous infusion

Administration

• Loading dose: administer undiluted
• Max rate:100 mg/minute
• For continuous IV infusions: dilute with compatible solutions and

administer at a rate not to exceed 100 mg/minute

PK/PD

Distribution: Vd: IV: 9 to 12 L

Protein binding: ~3%, primarily to plasminogen

Half-life elimination: ~2 hours

Excretion: Urine (>95% as unchanged drug)

Adverse

Effects

Hypersensitivity reactions, ocular effects, seizures and myoclonus,

thromboembolic effects, abdominal pain, headache, back pain

*Emerging data from prehospital and military data use

Author, year

Design/ sample size

Intervention & Comparison

Outcome

Morrison, 2012

○ Observational (n=896)

○ TXA 1g bolus + repeat prn

vs placebo.

o

All-cause mortality overall within 48

hours and in hospital mortality

significantly reduced with TXA

Roberts, 2013

○ Randomized placebo-

controlled

(n = 20,2011)

○ TXA 1g bolus + 1g over 8

hours vs placebo

○ All-cause mortality at 28 days was

significantly reduced by TXA

○ Treatment within 1 hour and 1-3 hours

from injury significantly reduced the risk

of death due to bleeding

Sprigg, 2018

○ Randomized placebo-

controlled

(n= 2325)

○ TXA 1 g bolus + 1g over 8 h

infusion vs placebo

○ Patients in the tranexamic acid group

experienced a reduction in early

deaths and serious adverse events, but

not long term functional status

Roberts, 2019

○ Randomized, placebo-

controlled

(n=12737)

○ TXA 1 g bolus + 1g over 8

hours vs placebo

○ Treatment within 3 h of injury reduced

head injury-related death.

Rowell, 2020

●

Tranexamic acid has been studied in pre-hospital, hospital, and combat setting in patients who have

sustained a traumatic injury

●

Efficacy of tranexamic acid was demonstrated in some studies above, while other studies failed to show a

significant difference in outcomes

●

Dosing of tranexamic acid varied significantly in the above studies, however one dosing regimen has been

widely adopted

●

Tranexamic acid has minimal adverse effects, is relatively inexpensive, and readily available in many settings

• Rhee P, Joseph B, Pandit V, et al. Increasing trauma deaths in the United States. Ann Surg.

2014;260(1):13-21. doi:10.1097/SLA.0000000000000600

• Callcut RA, Kornblith LZ, Conroy AS, et al. The why and how our trauma patients die: A

prospective Multicenter Western Trauma Association study. J Trauma Acute Care Surg.

2019;86(5):864-870. doi:10.1097/TA.0000000000002205

• Latif RK, Clifford SP, Baker JA, et al. Traumatic hemorrhage and chain of survival. Scand J

Trauma Resusc Emerg Med. 2023;31(1):25. Published 2023 May 24. doi:10.1186/s13049-023-

01088-8

• Hijazi N, Abu Fanne R, Abramovitch R, et al. Endogenous plasminogen activators mediate

progressive intracerebral hemorrhage after traumatic brain injury in mice. Blood.

2015;125(16):2558-2567. doi:10.1182/blood-2014-08-588442

• Cai J, Ribkoff J, Olson S, et al. The many roles of tranexamic acid: An overview of the

clinical indications for TXA in medical and surgical patients. Eur J Haematol. 2020;104(2):79-

• doi:10.1111/ejh.13348
• Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military Application of Tranexamic Acid

in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg. 2012;147(2):113-119.

doi:10.1001/archsurg.2011.287

• Roberts I, Shakur H, Coats T, et al. The CRASH-2 trial: a randomised controlled trial and

economic evaluation of the effects of tranexamic acid on death, vascular occlusive

events and transfusion requirement in bleeding trauma patients. Health Technol Assess.

2013;17(10):1-79. doi:10.3310/hta17100

• Sprigg N, Flaherty K, Appleton JP, et al. Tranexamic acid for hyperacute primary

IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled,

phase 3 superiority trial. Lancet. 2018;391(10135):2107-2115. doi:10.1016/S0140-

6736(18)31033-X

• CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular

occlusive events and other morbidities in patients with acute traumatic brain injury

• Micromedex [Electronic version].Greenwood Village, CO: Truven Health Analytics.

Retrieved January 17, 2021, from http://www.micromedexsolutions.com/