If printed, this document is valid only on 05/02/2016
LEEDS TEACHING HOSPITALS TRUST
eClinical Guidelines Template
Tranexamic acid in trauma (adults and children)
Guideline Detail
Ownership: Jonathan Jones, Consultant in Emergency Medicine, LTHT
Publication date:
Next Review date: June 2016
Clinical condition: Trauma
Target patient group: Emergency Department patients with trauma
Target professional group(s): Clinicians caring for ED patients with trauma
Contents
Summary of Guideline
Tranexamic acid has been found to improve outcome in adult patients with bleeding as
a result of trauma if administered within 3 hours of injury. Expert opinion is that this
finding in adults can be extrapolated to children.
All patients (adult and paediatric) without contra-indications who are bleeding or who
are at risk of significant bleeding as a result of trauma should be given tranexamic acid
(TXA) if the initial bolus dose can be given within 3 hours of injury.
Aims
To increase usage of tranexamic acid in the care of trauma patients
Objectives
To ensure familiarity with the indications, dosage and administration of tranexamic acid
in trauma patients thereby increasing usage and reducing mortality from haemorrhage.
Background
The CRASH-2 study has identified that tranexamic acid is a cheap and effective
pharmacological intervention in patients who may be bleeding as a result of trauma. The Royal
College of Paediatrics and Child Health has established guidance on the use of tranexamic acid
in paediatric trauma patients.
Diagnosis
All patients who have suffered trauma and who the senior clinician caring for them feels may be
bleeding or at risk of significant bleeding (and importantly not just those requiring massive
transfusion). Isolated head injuries are excluded.
Investigation
No investigations are required prior to the commencement of tranexamic acid. If no significant
bleeding is identified following investigation the tranexamic acid can be discontinued.
Treatment / Management
Note: The initial bolus dose may have been given pre-hospital - check with the pre-hospital
team.
Adults: 1gram intravenously over 10 minutes within 3 hours of the onset of haemorrhage
followed by a further 1gram intravenous infusion in 100ml sodium chloride 0.9% or glucose 5%
over 8 hours. The infusion should be stopped if investigations show that no significant bleeding
If printed, this document is valid only on 05/02/2016
has occurred.
Paediatrics: Loading Dose – 15mg/kg (max 1g) diluted in a convenient volume of Sodium
Chloride 0.9%
or Glucose 5% and given over 10 minutes
Maintenance infusion – 2mg/kg/hour. Suggested dilution 500mg in 500ml of sodium
chloride 0.9% or glucose 5% given at a rate of 2mls/kg/hour. For up to 8 hours. The infusion
should be stopped if investigations show that no significant bleeding has occurred. MAXIMUM
infusion dose of 1g.
Contraindications:
Relative (assess risk vs benefit on an individual patient basis). In many cases it will not be
possible to obtain a full history. If there is a realistic suspicion of significant bleeding the benefits
will most likely outweigh the risks.
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Patients with previous deep vein thrombosis (DVT), pulmonary embolism (PE)
or arterial thrombosis
History of convulsions
Patients with indwelling cardiac stent
Severe renal impairment (eGFR less than 29ml/min/1.73m2) due to risk of
accumulation. Toxicity in acute overdose is unlikely at doses of less than
140mg/kg (see National Poisons Information Service Toxbase [accessed 12th
June 2013]. Even a thin adult of 50kg would only be receiving 40mg/kg if given
the full 2g dosage. As the dose is not repeated the risk of accumulation even in
severe renal impairment is very slight.
Absolute
 Hypersensitivity to tranexamic acid or any of the ingredients
 Greater than 3 hours between time of injury and initial bolus dose
Tranexamic acid is associated with an increased risk of thrombosis. However in the
CRASH 2 study the treatment group had a lower incidence of thrombotic events. The
risks are felt to be very small.
Audit and Monitoring Compliance
Audit will be performed as part of the national Trauma Audit Research Network (TARN)
submissions and will be reported to the trust major trauma clinical governance forum.
Provenance:
Author name: Jonathan Jones, Consultant in Emergency Medicine
Clinical condition: Trauma
Target patient group: Emergency Department patients with trauma
Target professional group (clinical competence): Medical and nursing staff caring for
trauma patients.
Evidence Base:
References and Evidence levels:
If printed, this document is valid only on 05/02/2016

Crash 2 trial collaborators (June 2010) Effects of tranexamic acid on death,
vascular occlusive events, and blood transfusion in trauma patients with
significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial.
Lancet 2010 DOI:10.1016/S0140-6736(10)60835-5 (level of evidence: A)

RCPCH: Evidence Statement Major trauma and the use of tranexamic acid in
children. November 2012 (level of evidence: C)