Podcast 828: TXA Dosing Update

<p><strong>Contributor: Nick Hatch, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">In the setting of traumatic injury, tranexamic acid (TXA) is given to stabilize clots which minimizes bleeding and decreases risk of hemorrhagic shock  </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Current TXA dose for trauma is 1 g bolus followed by a 1 g infusion; both doses should be given within 3 hours from time of injury </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Due to the split dose and narrow window, patients with complicated care, particularly if they require transfer may miss the infusion dose </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Various smaller studies have shown that dosing 2 g initially or 2 g followed by a 1 g infusion produces the same patient outcomes and no additional harm </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Receiving hospitals should strive to acquire accurate information regarding previous doses of TXA given and confirm timeline of injury </span></li> </ul> <p> </p> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Roberts I, Shakur H, Coats T, et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients.</span> <em><span style="font-weight: 400;">Health Technol Assess</span></em><span style="font-weight: 400;">. 2013;17(10):1-79. doi:10.3310/hta17100</span></p> <p> </p> <p><span style="font-weight: 400;">Ramirez RJ, Spinella PC, Bochicchio GV. Tranexamic Acid Update in Trauma.</span> <em><span style="font-weight: 400;">Crit Care Clin</span></em><span style="font-weight: 400;">. 2017;33(1):85-99. doi:10.1016/j.ccc.2016.08.004</span></p> <p> </p> <p><span sty