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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