Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 1;96(2):216-224.
doi: 10.1097/TA.0000000000004177. Epub 2023 Oct 24.

A comparative analysis of tranexamic acid dosing strategies in traumatic major hemorrhage

Finn Gunn  1 , Rheanna Stevenson, Ateeq Almuwallad, Andrea Rossetto, Paul Vulliamy, Karim Brohi, Ross Davenport
Affiliations

A comparative analysis of tranexamic acid dosing strategies in traumatic major hemorrhage

Finn Gunn et al. J Trauma Acute Care Surg. .

Abstract

Introduction: Tranexamic acid (TXA) is a life-saving treatment for traumatic hemorrhage, but the optimal dosing regimen remains unknown. Different doses and treatment strategies have been proposed, including single bolus, repeated bolus, or bolus plus infusion. The aim of this study was to determine the effect of different TXA dosing strategies on clinical outcomes in bleeding trauma patients.

Methods: Secondary analysis of a perpetual cohort study from a UK Level I trauma center. Adult patients who activated the local major hemorrhage protocol and received TXA were included. The primary outcome was 28-day mortality. Secondary outcomes were 24-hour mortality, multiple organ dysfunction syndrome, venous thromboembolism, and rotational thromboelastometry fibrinolysis.

Results: Over an 11-year period, 525 patients were included. Three dosing groups were identified: 1 g bolus only (n = 317), 1 g bolus +1 g infusion over 8 hours (n = 80), and 2 g bolus (n = 128). Demographics and admission physiology were similar, but there were differences in injury severity (median Injury Severity Score, 25, 29, and 25); and admission systolic blood pressure (median Systolic Blood Pressure, 99, 108, 99 mm Hg) across the 1-g, 1 g + 1 g, and 2-g groups. 28-day mortality was 21% in each treatment group. The incidence of multiple organ dysfunction syndrome was significantly higher in the bolus plus infusion group (84%) vs. 1 g bolus (64%) and 2 g bolus (62%) group, p = 0.002, but on multivariable analysis was nonsignificant. Venous thromboembolism rates were similar in the 1-g bolus (4%), 2 g bolus (8%) and bolus plus infusion groups (7%). There was no difference in rotational thromboelastometry maximum lysis at 24 hours: 5% in both the 1-g and 2-g bolus groups vs. 4% in bolus plus infusion group.

Conclusion: Clinical outcomes and 24-hour fibrinolysis state were equivalent across three different dosing strategies of TXA. Single bolus administration is likely preferable to a bolus plus infusion regimen.

Level of evidence: Therapeutic/Care Management; Level III.

PubMed Disclaimer

References

    1. Cothren CC, Moore EE, Hedegaard HB, Meng K. Epidemiology of urban trauma deaths: a comprehensive reassessment 10 years later. World J Surg . 2007;31(7):1507–1511.
    1. Cole E, Weaver A, Gall L, West A, Nevin D, Tallach R, et al. A decade of damage control resuscitation: new transfusion practice, new survivors, new directions. Ann Surg . 2021;273(6):1215–1220.
    1. Demetriades D, Murray J, Charalambides K, Alo K, Velmahos G, Rhee P, et al. Trauma fatalities: time and location of hospital deaths. J Am Coll Surg . 2004;198(1):20–26.
    1. Cripps MW, Kutcher ME, Daley A, McCreery RC, Greenberg MD, Cachola LM, et al. Cause and timing of death in massively transfused trauma patients. J Trauma Acute Care Surg . 2013;75(2 Suppl. 2):255–262.
    1. Davis JS, Satahoo SS, Butler FK, Dermer H, Naranjo D, Julien K, et al. An analysis of prehospital deaths: who can we save? J Trauma Acute Care Surg . 2014;77(2):213–218.

LinkOut - more resources