Tranexamic Acid

Question 1

Tranexamic Acid: Introduction

Answer 1

Antifibrinolytic:

TXA is a synthetic derivative of the amino acid lysine that inhibits fibrinolysis (clot breakdown) by blocking the lysine binding site on plasminogen, competitively inhibiting the activation of plasminogen to plasmin

Question 2

Tranexamic Acid: Indication

Answer 2

Significant trauma (<3 hours) with signs of hypovolaemia

Significant active haemorrhage that requires the use of:
1) Tourniquets
2)Haemostatic dressing

Suspected head injury (<3 hours) with GCS motor score of 4 (withdrawing from pain) or below

Severe primary or secondary Post-Partum haemorrhage (>1000ml) or PPH with signs of hypovolaemia (birth/bleed occurred <3 hours)

Significant post-tonsillectomy haemorrhage

Question 3

Tranexamic Acid: Contraindications

Answer 3

Hypersensitivity

Injury time more than 3 hours (associated with increase in mortality)

Question 4

Tranexamic Acid: Considerations

Answer 4

HHDNDC

Hypotension (fast infusion rate)
Headache
Dizziness
Convulsions (lowers seizure threshold)
Nausea and/or vomiting
Diarrhoea

Question 5

Tranexamic Acid: Precautions

Answer 5

TXA administration should prompt transport to trauma centre

Rapid administration may lead to hypotension

No medications/blood products to be administered through TXA giving set.

Give as early as possible post event. Survival benefit reduced 10% per 15 mins.

Address critical interventions prior to administration of TXA

Slow IV push is preferred first line management due to lack of familiarity of infusions and lack of labels.

Safety during pregnancy has not been demonstrated, but should be administered if indications are met.