Many trauma centers insist on reinventing the wheel when it comes to policies and protocols. That’s why I like to share here. It’s so much easier to “borrow” from another center, tweak it until it works for yours, and save lots of time and effort.
Today, I’m sharing our adult “Adult Tranexamic Acid (TXA) in Trauma Patients” policy. The main points are:
- Indications – adult trauma patient with enough blood loss to require transfusion or activation of the massive transfusion protocol
- Timing – Only give if the injury was known to occur within 3 hours, not within 3 hours of arrival in your center
- Dosing – a simple loading dose of 1 gram in 50cc saline give slow push, followed by another gram infused over 8 hours
- Exclusion criteria – Although many are listed, the trauma team will only be able to find out about a few: use of anticoagulants, previous dosing of prothrombin complex concentrate (PCC) or Factor VIIa, and possibly the presence of subarachnoid hemorrhage if a CT has been obtained. If the infusion has already started when one of these criteria is identified, stop the infusion.
Suggestion: To keep your trauma professionals from forgetting this adjunct to resuscitation, consider putting a sign on your massive transfusion protocol coolers that says “Do You Need TXA?” And keep it in the med dispenser near/in your resuscitation rooms so you can get it quickly!