Tranexamic Acid in Trauma

Why this matters

Tranexamic acid stabilizes clot. It is for clinical hemorrhagic shock, after life-saving bleeding control, and only within 3 hours of injury. It is not a tourniquet. It does not replace surgery.

Do not draw it while arterial bleeding is still uncontrolled. If your service does not carry it, you are not failing the call. The protocol sets the dose and the mixing card. This page does not list grams. Pediatric use is not well studied.

Clinical sequence

1. Do the life-saving interventions first. A tourniquet, wound packing, and the airway still come before a drug. TXA comes after those, not instead of them.
2. Confirm clinical hemorrhagic shock. Low blood pressure, marked tachycardia, or obvious massive bleeding. A small scalp bleed is not this indication.
3. Check the clock from the time of injury, not from dispatch. If it has been more than three hours, do not start TXA for this indication. Do not try to catch up later.
4. Give it the way your protocol card says. An infusion or a slow push. It is not a fast adenosine-style push. Label the bag or the syringe so the hospital does not give another dose without knowing you already gave one.

Where It Fits

• Adult trauma with signs of hemorrhagic shock, after life-saving bleeding control and the rest of the MARCH sequence: massive hemorrhage, airway, respirations, circulation, and hypothermia or head injury. See massive hemorrhage and damage-control resuscitation.
• More than one dosing strategy is in use. The ideal dose is not settled. This site does not list grams. Your protocol sets the mixing, the rate, and whether you carry TXA at all.

Where It Does Not

• More than three hours from injury. Late TXA is not helpful for this indication.
• No clinical bleeding and no shock. Isolated minor trauma.
• Isolated traumatic brain injury without hemorrhagic shock is a different evidence base. Do not use this hemorrhagic-shock rule for that problem.
• Children: prehospital TXA in pediatric hemorrhagic shock is not well studied, and there is no standard field dose. If the pediatric protocol includes it, stay inside three hours from injury. This site will not invent a dose.
• A substitute for a tourniquet, packing, or an operating room.

Common errors

• Drawing TXA while arterial bleeding is still uncontrolled.
• Forgetting to tell the trauma bay it was given.
• Using dispatch time as the injury time when the crash was hours earlier.

Practice

Related: Massive Hemorrhage First, Wound Packing, Medication rights.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

• NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language. Your protocol still decides.
• NAEMSP / ACEP / ACS-COT 2025: Tranexamic Acid in Trauma — After life-saving interventions, in clinical shock, within 3 hours. The dose is not settled. The pediatric role is not established.
• CRASH-2 studied in-hospital TXA inside a 3-hour window. PATCH studied prehospital TXA and did not show a 6-month functional benefit. Your protocol decides whether you carry TXA.