The benefits of tranexamic acid almost seemed too good to be true. It’s cheap, easy to carry, has been used for decades within hospital and GP settings – and seems to offer absolute benefits in promoting haemostasis, with no side effects. It also fits very well into the ‘damage limitation’ approach that has changed much of prehospital trauma care over the last few years. In addition, military experience, particularly from Afghanistan, has accelerated the availability of high quality practical data on its use in challenging environments.
Now, there is some solid and pragmatic advice on the administration of tranexamic acid, including a Cochrane review which has been published in December last year:
It appears that it is now at a point that many practitioners can and should be considering its use. Especially for areas where transfer to a surgical or major trauma unit is likely to be delayed – such as rural and remote areas of Scotland – it could offer vital life-saving benefits of reduced blood loss and extended survival times in the context of major trauma.
Administration is relatively straightforward. Where there is evidence of a ‘positive primary survey’ – i.e. where pulse, blood pressure/capillary refill time or respiration rate are impaired due to suspected haemorrhage, resulting from trauma in the last 3 hours, the following treatment is suggested:
- Inject two 500mg vials (1g) of tranexamic acid into a 100mL bag of normal saline. Give this IV over 10-20 minutes (loading dose).
- Inject two 500mg vials (1g) of tranexamic acid into a 500mL bag of normal saline. Give this IV over 8 hours (maintenance dose).
Commonly, where transfer to hospital or extrication takes less than 30 minutes, the maintenance dose can be more safely given once the patient is in a facility that can provide an IV pump to give this over a more exact time.
Crash 3 Trial
The investigators are now busy conducting the Crash 3 trial which will look at the effects of tranexamic acid specifically on traumatic brain injury. They’ve produced a video explaining the new trial procedure – which also highlights some of the key points of using tranexamic acid above.