Tranexamic acid (TXA) is an anti-fibrinolytic agent that inhibits fibrinolysis by blocking lysine binding sites on plasminogen. It is indicated for suspected severe traumatic hemorrhagic shock or following traumatic arrest if resuscitation is indicated. Contraindications include isolated head injury, hypersensitivity, history of thromboembolic disease, or current thromboembolic event. The dosage for traumatic injury is a 10 minute bolus followed by an 8 hour infusion, while traumatic arrest receives a single bolus. TXA must be initiated within 3 hours of injury and the receiving facility notified upon arrival.

1. Tranexamic Acid (TXA)
Medication:
Anti-fibrinolyticagent
Mechanismof Action:
 A syntheticderivativeof lysinethatcompetitively inhibitsfibrinolysisby blockinglysine binding
sitesonplasminogenand preventingitsactivationtoplasmin.
Indications:
 SuspectedseveretraumatichemorrhagicshockwithSBP< 90mmHg and HR > 110bpm
Or
 Followingtraumaticarrestif resuscitationisindicatedandPEA rate > 30bpm or EtCO2 > 10 at
any time duringresuscitationattempt.
Contraindications:
 Isolatedheadinjury
 Knownhypersensitivity
 < 16 Yearsof age
 Historyof knownthromboembolicdisease within6months (ie.DVT,PE,etc…)
 Anyindicationof currentthromboembolicevent (AMI,CVA,PE,etc…)
Side effects:
 Seizure
 VisionChanges
 Renal Impairment
 Hypotensionassociatedwithrapidinfusion
Dosage Administration:
 Traumatic injury:
o Bolus1gm mixedin100cc NS over10 minutes(600mL/hr)
o FollowwithIV infusionof 1gm in250cc NS over8 hours(31mL/hr)
 Traumatic Arrest:
o Administer1gmTXA IVP
PEARLS:
 MUST be initiatedwithin3hoursof injury(Mosteffective if initiatedwith1hour)
 MUST notifyreceivingfacilityof receipt of bolusandcontinuationof infusionimmediatelyupon
arrival at trauma center.
 May be administeredIV orIO.
 CANNOTbe giveninthe same line asbloodproducts,penicillin,or FactorVIIa(surgical
considerations)

2.  MUST establishbilateral IV accesspointspriortoadministrationof TXA
 12 Lead EKG MUST be performedpriortoadministrationof TXA forpatientwithtraumatic
injury.12 leadEKG is notindicatedforpatientsintraumaticarrest.
 PregnancyClassB