Use of Tranexamic Acid in Trauma Patients

Use of tranexamic acid in trauma patients
Tranexamic acidis an antifibrinolytic agent and inhibits the activation of
plasminogen to plasmin.
Trial data (CRASH-2) [ Reference :Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with
significant hemorrhage (CRASH-2): a randomised, placebo-controlled trial,
The Lancet, Vol 376, issue 9734, 23-32; 3 July 2010 ] showed that the administration of tranexamic acid to adult trauma patients with, or at risk of, significant hemorrhage, within 8 hours of injury significantly reduces all-cause mortality with no apparent increase in vascular occlusive events.
Early use of tranexamic acid should be considered for all patients with trauma and significant hemorrhage.
Patients with isolated head injury should not routinely receive tranexamic acid as risk of thrombosis exists.
• Use within 3 hours of injury is recommended.
• Initial use of tranexamic acid should be avoided when time from injury is known or suspected to be greater than 3 hours.
• Tranexamic acid is given as 1 gram loading dose in 100ml 0.9% normal saline over 10 min in a separate line from blood or blood products.
• Infuse a second 1 gram dose of tranexamic acid in 0.9% normal saline
over 8 hours.
• There is no evidence from randomised trials to support additional administration of tranexamic acid in trauma patients after the initial two doses. Further use should be discussed with an on-call haematology consultant.



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