Tranexamic Acid (TXA) & Uncontrolled Bleeding
Medication that stabilizes clots for traumatic, uncontrolled bleeding
⚠️ Time Critical: Must give within 3 hours of injury/bleeding onset to be effective!
Indications - Use TXA If:
Major, uncontrolled, traumatic bleeding with shock symptoms AND <3 hours since injury:
- Uncontrolled blood loss from major trauma
- Post-partum hemorrhage
- GI bleeding (onset <3 hours)
- Epistaxis (with CDM support)
Shock Symptoms Include:
- BP <90 systolic
- Pallor, cool extremities
- Confusion, dizziness
- Delayed capillary refill
- Heart rate >110 bpm
Contraindications - Do NOT Give If:
| Contraindication |
|---|
| Allergy/hypersensitivity to TXA |
| >3 hours since injury/bleed |
| History of convulsions/seizure disorder |
| Severe renal disease (especially dialysis, GFR <30) |
| Brain bleed |
| Age below 16 |
| Isolated limb trauma (manual bleeding management required - increased risk of clots/vascular occlusion) |
Treatment - ALL Patients
- Arrange transfer to hospital
- Treat cause of bleed (bind pelvis, pack wounds)
- Start bilateral IVs with warm fluids
FR, EMR, LPN, OFA, RPN
- Stay with patient until transfer
- Apply direct pressure with gloved hand
- Apply bandage/pressure dressing and elevate wound
- If not controlled, apply tourniquet proximal to injury (extremity trauma only)
TXA Administration (PCP, ACP, RN, NP, PA, MD)
Dose: 1-2 grams (1000-2000 mg) TXA
Option 1: Diluted in 250cc NS
- Infuse over 10 minutes
- Run IV at 4 drops/second (#10 drip set)
- Do not repeat
Option 2: Diluted in 50cc NS
- Infuse over 10 minutes (1 drop/second with #10 drip set)
- Ensure secondary set at higher elevation than main bag
- Do not repeat
Option 3: IV Push
- 1-2 grams in 10cc syringe
- Push at 1cc (100mg) every 1-2 minutes over 10 minutes
- Do not repeat
Side Effects
- Anaphylaxis
- Low blood pressure (with rapid administration)
- Seizures
- Nausea/vomiting/diarrhea
- Dizziness
- Visual abnormalities
Disposition
When calling for transfer:
- Specify that TXA has been given
- Transfer may require ALS responders in some provinces
- CDM may need to accompany patient
- TXA not part of all provincial protocols currently
⚠️ Remember: TXA may not be available on urban deployments with timely ambulance response. Typically included after event risk assessment showing increased trauma risk and prolonged response times.
Source: Odyssey Medical Consulting
Version: 2023-06-21