TXA Tranexamic Acid

Question 1

TXA Introduction

Answer 1

Antifibrinolytic

Tranexamic Acid (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.

Hepatic metabolism with renal excretion.

– Onset: Within minutes
– Duration: 17 hours
– Half-life: 3 hours

Question 2

TXA Indications

Answer 2

• Significant trauma (< 3 hours) with signs of hypovolaemia or
• Significant active haemorrhage that requires the use of
• • Tourniquet/s
• • Haemostatic/pressure dressing/s
• Suspected head injury (< 3hours) with GCS motor score of 4 (withdrawing from pain) or below
• Severe Primary or Secondary Post-Partum Haemorrhage (> 1000 mL) or PPH with signs of hypovolaemia (birth/bleed occurred < 3hrs)
• Significant post-tonsillectomy haemorrhage

Question 3

TXA Contraindications

Answer 3

• Known hypersensitivity to Tranexamic Acid.
• Injury time more than 3 hours (associated with increase in mortality).

Question 4

TXA Precautions / Notes

Answer 4

• TXA administration in the traumatic patient in the metropolitan area should ordinarily prompt transport to a major trauma centre
• Rapid administration may lead to hypotension and dizziness.
• No medications or blood products (except 0.9% Sodium Chloride Solution) should be added or co-administered through the same giving set.
• Give as early as possible post event. Survival benefit is reduced by 10% for every fifteen minute delay with no benefit seen after 3 hours
• Address critical interventions (airway management, control of major haemorrhage etc.) before administration of tranexamic acid.
• Tranexamic acid administration should not delay transfer, noting it may be administered en route.
• Slow IV push is the first line management option. TXA can be given via an infusion, however, familiarity in using infusions and availability of an appropriate label to identify the infusion should dictate if this option is utilised.
• Safety during pregnancy has not been demonstrated, but the balance of risk is such that it should be administered if the indications are met in life threatening circumstances

Question 5

TXA Special Considerations

Answer 5

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