Significant haemorrhage following trauma: tranexamic acid

NICE advice [ESUOM1] Published date:

Key points from the evidence

Tranexamic acid is an antifibrinolytic agent used to prevent, stop or reduce unwanted bleeding. It is licensed for use as a tablet or injection to prevent or reduce bleeding for a range of other indications such as menorrhagia.

Following trauma, tranexamic acid can be administered as an intravenous bolus injection followed by an infusion over 8 hours. However, it does not currently have a UK marketing authorisation for the prevention or treatment of significant haemorrhage following trauma. Use of tranexamic acid in trauma patients will be off-label.

Evidence from a large, high-quality international randomised controlled trial (RCT) shows that a short course of tranexamic acid given within 8 hours of injury to adult trauma patients with, or at risk of, significant bleeding, improved all cause mortality.

A further, exploratory analysis found that death due to bleeding was reduced if tranexamic acid was administered up to 3 hours from injury. However, death due to bleeding seemed to increase with administration later than 3 hours after injury.

A health economic analysis has found that tranexamic acid for the prevention and treatment of significant haemorrhage in trauma patients has an incremental cost of $64 international dollars (£43) per life saved.

RCPCH statement on the use of tranexamic acid in children for major trauma

Get involved