Tranexamic acid is a synthetic derivative of the amino acid lysine. It inhibits fibrinolysis by blocking the lysine binding sites on plasminogen.
Serious bleeding (significant haemorrhage) and its complications are a considerable cause of death following severe trauma and are responsible for 80% of deaths in the operating theatre and up to 50% of deaths in the first 24 hours after injury.
A European guideline provides some advice on alternative treatments. This guideline was published in 2010, before the reports on the CRASH-2 study. It is due to be updated and it is not yet known what the recommendations for tranexamic acid will be in the updated guideline.
The guideline advises that appropriate care for a patient with significant haemorrhage from trauma includes early identification of potential bleeding sources followed by prompt measures to minimise blood loss, restore the circulating blood volume and achieve stability. Resuscitation and surgical intervention can be a major part of this. The options for coagulation management discussed guideline include:
calcium, if ionised calcium is low
fresh frozen plasma for coagulopathy
platelet concentrates to maintain platelet levels
fibrinogen or cryoprecipitate
recombinant activated coagulation factor VII (in specific circumstances)
prothrombin complex concentrate (in specific circumstances).
Blood transfusions can also be given to the patient if required and the European Guideline recommends a target haemoglobin of 7 to 9 g/dl.
 CRASH-2 trial collaborators. (2010) Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 376: 23–32.
 Association of Anaesthetists of Great Britain and Ireland (AAGBI). (2010) Blood transfusion and the anaesthetist: management of massive haemorrhage. Anaesthesia 65: 1153–61.
 Rossaint R, Bouillon B, Cerny V et al. (2010) Management of bleeding following major trauma: an updated European Guideline. Critical Care 14: R52.