UNCONTROLLED WHEN PRINTED
 Introduction

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
 Indications
  • 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
 Contraindications
  • Known hypersensitivity to Tranexamic Acid.
  • Injury time more than 3 hours (associated with increase in mortality).
 Precautions / Notes
  • 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.
  • 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.
  • 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
 Preparation
Preparation
 Management
 Weight-based Calculations
 
Clear
 kg 
Mode: 
Weight: 
IV Tranexamic Acid for risk of significant bleeding (/mL)
Presentation: 1000mg:10mL
Calculated dose:  in

Adult IV / IO:

  • 1 g slowly over 10 minutes (Rapid administration may cause hypotension)
    SINGLE DOSE ONLY

Paediatric (<12 years) IV / IO:

  • 15 mg/kg slowly over 10 minutes (max injection rate 50 mg/minute)
    SINGLE DOSE ONLY
 Special Considerations
  • Hypotension (fast infusion rate)
  • Headache
  • Dizziness
  • Convulsions (lowers seizure threshold)
  • Nausea and/or vomiting
  • Diarrhoea
Presentation
1 g Tranexamic Acid in 10 mL vial (100 mg/mL).

TXA

Settings
Current mode:
Extended Care:
Colour assist:

References

The CRASH-2 Collaborators (2010) Effects of Tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 377. 9771: 1096

WOMAN Trial Collaborators. Effects of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in woman with post-partum haemorrhage (WOMAN): an international, randomised, double blind, placebo-controlled trial. Lancet 2017: 389: 2105- 16

Morison JJ, Dubose JJ, Ramussen TE, et al Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study Ach Surg 2012; 147: 113-19


Document Control


Directorate
Clinical Services

Responsible Manager
Head of Clinical Services

Version

Issue Date

Expiry Date

Clinical Resources Website

St John Ambulance Western Australia Ltd (ABN 55 028 468 715) (St John WA) operates ambulance and other pre-hospital clinical services. St John WA’s Clinical Resources, including its Clinical Practice Guidelines (Clinical Resources), are intended for use by credentialed St John WA staff and volunteers when providing clinical care to patients for or on behalf of St John WA, within the St John WA Clinical Governance Framework, and only to the extent of the clinician’s authority to practice.

Other users – Terms of Use

The content of the St John WA Clinical Resources is provided for information purposes only and is not intended to serve as health, medical or treatment advice. Any user of this website agrees to be bound by these Terms of Use in their use of the Clinical Resources.

St John WA does not represent or warrant (whether express, implied, statutory, or otherwise) that the content of the Clinical Resources is accurate, reliable, up-to-date, complete or that the information contained is suitable for your needs or for any particular purpose. You are responsible for assessing whether the information is accurate, reliable, up-to-date, authentic, relevant, or complete and where appropriate, seek independent professional advice.

St John WA expressly prohibits use of these Clinical Resources to guide clinical care of patients by organisations external to St John WA, except where these organisations have been directly engaged by St John WA to provide services. Any use of the Clinical Resources, with St John WA approval, must attribute St John WA as the creator of the Clinical Resources and include the copyright notice and (where reasonably practicable) provide a URL/hyperlink to the St John WA Clinical Resources website. 

No permission or licence is granted to reproduce, make commercial use of, adapt, modify or create derivative works from these Clinical Resources. For permissions beyond the scope of these Terms of Use, including a commercial licence, please contact medservices@stjohnambulance.com.au

Where links are provided to resources on external websites, St John WA:

  • Gives no assurances about the quality, accuracy or relevance of material on any linked site;
  • Accepts no legal responsibility regarding the accuracy and reliability of external material; and
  • Does not endorse any material, associated organisation, product or service on other sites.

Your use of any external website is governed by the terms of that website, including any authorisation, requirement or licence for use of the material on that website.

To the maximum extent permitted by law, St John WA excludes liability (including liability in negligence) for any direct, special, indirect, incidental, consequential, punitive, exemplary or other loss, cost, damage or expense arising out of, or in connection with, use or reliance on the Clinical Resources (including without limitation any interference with or damage to a user’s computer, device, software or data occurring in connection with such use).

Cookies

Please read this cookie policy carefully before using Clinical Resources from St John WA.

The cookies used on this site are small and completely anonymous pieces of information and are stored on your computer or mobile device. The data that the cookies contain identify your user preferences (such as your preferred text size, scope / skill level preference and Colour Assist mode, among other user settings) so that they can be recalled the next time that you visit a page within Clinical Resources. These cookies are necessary to offer you the best and most efficient possible experience when accessing and navigating through our website and using its features. These cookies do not collect or send analytical information back to St John WA.

Clinical Resources does integrate with Google Analytics and any cookies associated with this service enable us (and third-party services) to collect aggregated data for statistical purposes on how our visitors use this website. These cookies do not contain personal information such as names and email addresses and are used to help us improve your user experience of the website.

If you want to restrict or block the cookies that are set by our website, you can do so through your browser setting. Alternatively, you can visit www.internetcookies.com, which contains comprehensive information on how to do this on a wide variety of browsers and devices. You will find general information about cookies and details on how to delete cookies from your device. If you have any questions about this policy or our use of cookies, please contact us.

St John Ambulance Western Australia Ltd © Copyright 2020, All Rights Reserved

Terms of Use | Privacy Policy | Copyright Statement & Disclaimer