Tranexamic Acid FAQs​

With the addition of this medication in ALS PCS 5.4 we wanted to review some common questions

 

Q1) Can I titrate TXA when giving it IV?​

• No. TXA is administered via a single DOSE​
  • However, this dose is administered over time (1 gram over at least 5 min)​
• There is no benefit to administering partial doses or aliquots of TXA​
  • There is no reliable way to measure desired effect​
  • Unlike with other medications we titrate wherein an effect is used to consider further dosing​
    • Example: IV Naloxone​

Therefore, when administering TXA via IV route, the patient should receive the full dose by slow infusion

Q2) When should I choose IM vs IV TXA?​

• Choose the route that works best in your clinical circumstance. Weigh the pros/cons​
• IV route requires patent access and a slow infusion over at least 5minutes​
• IM requires multiple injections into multiple sites to administer the large volume of medication​
• Things to consider when choosing a route of administration might include; ​
  • time and ability to setup and establish IV access ​
  • ability to access multiple limbs of the patient​
  • supplied volume of saline for TXA infusion (need to give full volume to get the full dose)​

Q3) Can I give TXA to a patient in cardiac arrest?​

• No. ​
  • Currently there are no studies or other evidence to support the use of TXA in cardiac arrest​
  • The Traumatic Hemorrhage Medical Directive was designed to mirror the parameters of the CRASH-2 trial. This study focused on the effectiveness of TXA in preventing death in trauma patients. If death has already occurred, there is no indication to administer TXA​

Therefore, TXA is not to be considered for the trauma patient in cardiac arrest. Instead focus on other aspects of your trauma resuscitation ​

Q4) If a patient gets TXA Should I utilize FTTS and go ​to the LTC?​

• Not necessarily. TXA Indications ≠ FTTS Indications​
  • Recall that the Indications/Conditions for TXA administration within the Traumatic Hemorrhage Medical Directive are different from the Field Trauma Triage Standard criteria​
  • There may be some overlap, but there are differences​
• See a previous SWORBHP Tip on FTTS vs TXA released

Summary​

• When administering TXA via IV route, the patient should receive the full dose by slow infusion. No titration.​
• Either IV or IM route can be utilized. Use whichever route makes sense for your unique clinical consequence​
• TXA is only for patients that are not in cardiac arrest​
• TXA indications ≠ FTTS Indications. ​
• Do not delay transport to administer TXA!​

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No additional resources available for this #SWORBHPTip.