From the Guidelines
Tranexamic acid (TXA) can be safely administered concurrently with blood transfusions to manage severe bleeding, with no significant adverse interactions between TXA and blood products reported in the literature 1.
Administration and Dosage
The standard adult dose of TXA for trauma or surgical bleeding is typically 1 gram given intravenously over 10 minutes, followed by 1 gram over 8 hours, as recommended by the European guideline for the management of bleeding and coagulopathy following major trauma 1. When administering TXA with blood products, it should be given through a separate IV line or port to prevent any physical incompatibility with blood components. TXA works by inhibiting fibrinolysis (the breakdown of blood clots), while blood transfusions replace lost blood volume and components, making them effective partners in managing hemorrhage.
Side Effects and Precautions
Some patients may experience minor side effects from TXA such as nausea, vomiting, or hypotension, but these are not typically worsened by concurrent blood administration 1. TXA should be used cautiously in patients with a history of thromboembolic disorders, as it may theoretically increase clotting risk, though clinical evidence suggests the benefits outweigh risks in acute bleeding scenarios. The use of TXA in bleeding trauma patients has been shown to reduce the risk of death due to bleeding, with no evidence of increased risk of thrombosis, especially myocardial infarction 1.
Clinical Practice Guidelines
The European Society of Intensive Care Medicine has developed evidence-based clinical practice recommendations regarding transfusion practices and transfusion in bleeding critically ill adults, which include the use of tranexamic acid 1. However, the most recent and highest quality study on the use of TXA in trauma patients is the CRASH-2 trial, which demonstrated the efficacy and safety of TXA in reducing the risk of death due to bleeding 1. Therefore, the administration of TXA concurrently with blood transfusions is a recommended practice in the management of severe bleeding, based on the strongest and most recent evidence available 1.
Key Points
- TXA can be safely administered concurrently with blood transfusions
- No significant adverse interactions between TXA and blood products
- Standard adult dose of TXA: 1 gram IV over 10 minutes, followed by 1 gram over 8 hours
- Use cautiously in patients with a history of thromboembolic disorders
- Benefits of TXA outweigh risks in acute bleeding scenarios, based on the most recent and highest quality evidence available 1.
From the Research
Administration of Blood and TXA
- It is possible to administer blood and tranexamic acid (TXA) at the same time, as TXA is often used to reduce transfusion requirements in surgical patients 2, 3.
- TXA has been shown to be effective in reducing blood loss and transfusion requirements in various surgical procedures, including cardiac surgery and orthopedic surgery 2, 3.
Reactions to Blood and TXA Administration
- The use of TXA has been associated with an increased risk of thromboembolic events in severely injured hemorrhaging trauma patients 4.
- The incidence of thromboembolic events in patients receiving TXA was found to be 10% in one systematic review, with an odds ratio of 2.6 compared to those not receiving TXA 4.
- Other procoagulant therapies, such as fibrinogen concentrate, have also been associated with an increased risk of thromboembolic events 4.
- The use of alternative blood products, such as prothrombin complex concentrate and recombinant factors, may also be considered in trauma patients, but their safety and efficacy are still being researched 5.