Tranexamic acid

Background

Action: Antifibrinolytic agent
Competitive inhibitor of plasminogen activation to plasmin
Dosing Availability:
- Ampule of 1 Gm in 10 mL

Indication

Severely bleeding trauma patient, systolic blood pressure of <90 and/or heart rate > 110 beats/min, with expected requirement for massive transfusion.

Contraindication/Exclusion Criteria

Greater than 3 hours from injury
Known sensitivity to TXA
Previous DVTor Pulmonary Embolism

Administration

Adult dose

Total of 2 Grams

Initial bolus of 1 Gm over 10 minutes (Slow IV push). Draw up with filter needle.
Maintenance: additional 1 Gm over next 8 hours (mix in 50 mL of NS). Call Pharmacy to mix and deliver the continuous infusion.^[1]

Pediatric dose

Weight based

Initial bolus of 20mg/kg IV Bolus over 10 minutes
Maintenance: 10 mL/kg/hr over next 8 hours

No additional laboratory tests required.

Adverse Reactions

Thrombotic events
Hypotensionwith rapid injection
Nausea, vomiting, diarrhea
Impaired color vision and other visual disturbances

External Links

References

↑ CRASH-2 collaborators, Roberts I, Shakur H, Afolabi A, Brohi K, Coats T, Dewan Y, Gando S, Guyatt G, Hunt BJ, Morales C, Perel P, Prieto-Merino D, Woolley T. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011 Mar 26;377(9771):1096-101,

Authors:

[1] CRASH-2 collaborators, Roberts I, Shakur H, Afolabi A, Brohi K, Coats T, Dewan Y, Gando S, Guyatt G, Hunt BJ, Morales C, Perel P, Prieto-Merino D, Woolley T. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011 Mar 26;377(9771):1096-101,

[1]