From the Guidelines
There is no evidence to support the use of intramuscular (IM) tranexamic acid (TXA) in human studies, as the current guidelines and studies only recommend intravenous administration of TXA for bleeding trauma patients. The most recent and highest quality study, 1, recommends that tranexamic acid be administered as early as possible to the trauma patient who is bleeding or at risk of significant hemorrhage at a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 h. This study does not mention the use of intramuscular TXA, and the recommended administration route is intravenous.
Key Points
- The current guidelines recommend intravenous administration of TXA for bleeding trauma patients 1.
- There is no evidence to support the use of intramuscular TXA in human studies.
- The pharmacokinetics and efficacy of intramuscular TXA are not well-established in human studies.
- The use of intravenous TXA has been shown to reduce mortality and morbidity in trauma patients with significant bleeding 1.
Administration Route
The recommended administration route for TXA is intravenous, as stated in the guidelines 1. The use of intramuscular TXA is not supported by current evidence, and its safety and efficacy are not well-established. In emergency situations where establishing IV access may delay treatment, other alternatives, such as administering TXA at the pre-hospital site of injury, should be considered 1.
Clinical Implications
In clinical practice, the use of intravenous TXA should be prioritized for bleeding trauma patients, as it has been shown to reduce mortality and morbidity 1. The administration of TXA should be planned and protocols for the management of bleeding patients should consider administration of the first dose of TXA at the site of injury, if possible 1.
From the Research
Human Studies of Intramuscular (IM) Tranexamic Acid (TXA)
- There have been human studies of IM TXA, including a case report of a patient who received IM TXA due to inability to obtain IV/IO access in a battlefield environment 2.
- A pharmacokinetic study compared the bioavailability of TXA administered via IV, IM, and oral routes in healthy volunteers, finding that IM bioavailability was 105% 3.
- Other studies have discussed the clinical use of TXA, including its administration routes, but have not specifically focused on IM TXA 4, 5, 6.
- The available evidence suggests that IM TXA may be a viable alternative to IV/IO administration in certain situations, but further research is needed to fully understand its efficacy and safety 2, 3.