Tranexamic acid is an antifibrinolytic agent and inhibits the activation of plasminogen to plasmin.

Trial data (CRASH-2)¹ showed that the administration of tranexamic acid to adult trauma patients with, or at risk of, significant haemorrhage, 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 haemorrhage.
• 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.

→ Section 11.a

Tranexamic acid

The East of England Ambulance NHS Trust has developed a PGD in conjunction with the Trauma Network for paramedic administration of tranexamic acid in the first 3 hours after injury.