Tranexamic Acid in Trauma - 20/08/25
, Kevin A. Kaucher b, Ross E. Orpet c, Eric M. Campion d, Jeffrey M. Goodloe e, Peter Fischer f, Christopher B. Colwell g, John W. Lyng hAbstract |
A Joint Position Statement and Resource Document of NAEMSP, ACEP, and ACS-COT
Prehospital use of tranexamic acid (TXA) has grown substantially over the past decade despite contradictory evidence supporting its widespread use. Since the previous guidance document on the prehospital use of TXA for injured patients was published by the National Association of EMS Physicians, the American College of Surgeons Committee on Trauma, and the American College of Emergency Physicians in 2016, new research has investigated outcomes of patients who receive TXA in the prehospital setting. To provide updated evidence-based guidance on the use of intravenous TXA for injured patients in the emergency medical services (EMS) setting, we performed a structured literature review and developed the following recommendations supported by the evidence summarized in the accompanying resource document.
The National Association of EMS Physicians, the American College of Surgeons Committee on Trauma, and the American College of Emergency Physicians recommends:
• | Prehospital TXA administration may reduce mortality and improve long-term functional outcomes in adult trauma patients with hemorrhagic shock when administered after lifesaving interventions. |
• | Prehospital TXA administration appears safe, with low risk of thromboembolic events or seizure. |
• | The ideal dose, rate, and route of prehospital administration of TXA for adult trauma patients with hemorrhagic shock has not been determined. Current protocols suggest EMS agencies may administer either a 1-g intravenous (IV) or intraosseous (IO) dose (followed by a hospital-based 1-g infusion over 8 hours), or a 2-g IV or IO dose as an infusion or slow push. |
• | Prehospital TXA administration, if used, for adult trauma patients, should be given to those with clinical signs of hemorrhagic shock and no later than 3 hours postinjury. There is no evidence to date to suggest improved clinical outcomes from TXA initiation beyond this time or in those without clinically significant bleeding. |
• | The role of prehospital TXA in pediatric trauma patients with clinical signs of hemorrhagic shock has not been studied and standardized dosing has not been established. If used, it should be given within 3 hours of injury. |
• | Prehospital TXA administration, if used, should be clearly communicated to receiving health care professionals to promote appropriate monitoring and to avoid duplicate administration(s). |
• | A multidisciplinary team, led by EMS physicians, that includes EMS clinicians, emergency physicians, and trauma surgeons should be responsible for developing a quality improvement program to assess prehospital TXA administration for protocol compliance and identification of clinical complications. |
Plan
| Funding: This document was developed by NAEMSP, ACEP, and ACS without external funding. |
|
| Contributions: REO, KAK, WJB, CBC developed the plan for literature review and evidence extraction. All authors assume full responsibility for the collection and integrity of the data. REO, KAK, WJB, and EMS participated in the evidence extraction, data analysis, development of the clinical practice guideline. All authors participated in editing. All authors assume full responsibility for the entire content of the manuscript. |
|
| Potential Conflict of Interest: |
|
| External review: This document was created jointly by the National Association of EMS Physicians (NAEMSP), the American College of Surgeons Committee on Trauma (ACS-COT), and the American College of Emergency Physicians (ACEP). It has been independently reviewed and approved by each participating organization (NAEMSP 29 October 2024, ACS-COT 11 October 2024, ACEP 22 January 2025). |
|
| Updating procedure: This document will be reviewed and updated by NAEMSP, ACS-COT, and ACEP 5 years after its publication. At a minimum, the review process should include a search and synthesis of any new and relevant evidence that has been published since the printing of this document. |
|
| This statement is jointly published in Annals of Emergency Medicine, Prehospital Emergency Care, and Journal of Trauma and Acute Care Surgery. |
Vol 86 - N° 3
P. e73-e80 - septembre 2025 Retour au numéro
Article précédent
- Regional Anesthesia as a New Required Core Procedure for Emergency Medicine Residents: A Step in the Right Direction
- Richard J. Gawel, Michael Gottlieb, Michael E. Abboud, Jeffrey A. Kramer, Michael Shalaby
- Table of Contents
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?