From the Guidelines
Tranexamic acid (TXA) should be administered early in a massive transfusion protocol, ideally within 3 hours of injury or hemorrhage onset, and no later than 8 hours post-injury, at a loading dose of 1 g infused over 10 min, followed by an intravenous infusion of 1 g over 8 h, as recommended by the most recent guidelines 1.
The use of TXA in massive transfusion protocols is supported by high-quality evidence, including the CRASH-2 trial, which demonstrated a significant reduction in all-cause mortality and death due to bleeding with early TXA administration 1. The European guideline on management of major bleeding and coagulopathy following trauma also recommends TXA administration as soon as possible, ideally within 3 hours of injury, and no later than 8 hours post-injury 1.
Key points to consider when using TXA in massive transfusion protocols include:
- Early administration, ideally within 3 hours of injury or hemorrhage onset
- Loading dose of 1 g infused over 10 min, followed by an intravenous infusion of 1 g over 8 h
- Consideration of TXA as part of the initial resuscitation efforts alongside blood products, not as a replacement for them
- Contraindications, including active thromboembolic disease, subarachnoid hemorrhage, and hypersensitivity to TXA
The most recent guidelines and evidence support the use of TXA in massive transfusion protocols, and it is essential to prioritize its early administration to maximize its benefits in reducing morbidity, mortality, and improving quality of life 1.
From the FDA Drug Label
1 INDICATIONS & USAGE Tranexamic acid injection is indicated in patients with hemophilia for short-term use (2 to 8 days) to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction.
The FDA drug label does not answer the question.
From the Research
Tranexamic Acid (TXA) in Massive Transfusion Protocol
- TXA is used to reduce blood loss by inhibiting the enzymatic breakdown of fibrin 2
- The CRASH-2 trial showed that TXA safely reduces mortality in bleeding trauma patients when administered within 3 hours of injury 2
- TXA can be administered to a wide spectrum of bleeding trauma patients, including those with massive transfusion protocol 3
Indications for TXA in Massive Transfusion Protocol
- TXA should be considered in trauma patients with suspected major bleeding, particularly those who require massive transfusion 3
- The administration of TXA within 8 hours of injury has been shown to significantly reduce mortality 3
- TXA can be used in conjunction with other hemostatic agents, such as recombinant factor VIIa, to prevent surgical bleeding in patients with factor XI deficiency 4
Timing of TXA Administration
- TXA should be administered as soon as possible after injury, ideally within 3 hours 2
- The median time to TXA administration in one study was 64 minutes after injury 5
- Delayed administration of TXA may reduce its effectiveness in reducing mortality and blood loss 2
Benefits and Limitations of TXA
- TXA has been shown to reduce the risk of bleeding trauma death without altering the need for blood transfusion 5
- TXA inhibits fibrin(ogen)olysis during the early stage of severe trauma, although this may not be associated with a reduction in transfusion volume 5
- The use of TXA may not be suitable for patients with pre-existing risk factors for thrombosis 4