Written by Ketan Patel
Spoon Feed
Prehospital tranexamic acid (TXA) administration within 3 hours may improve mortality risk in adult trauma patients with hemorrhagic shock and has minimal side effects.
No shock, no TXA: Target bleeding in trauma within 90 minutes
Despite widespread adoption, TXA dosing, route, and usage in certain populations has not been uniformly implemented in the prehospital setting. This article updates the 2016 NAEMSP/ACE/ACS-COT guidance.
This structured literature review informing the position statement covered when and how TXA should be used to improve outcomes in prehospital trauma care. They concluded that TXA may reduce mortality in adult hemorrhagic shock when given after lifesaving interventions and within 3 hours of injury. Safety evaluation clearly found a low thromboembolic and seizure risk with TXA. The optimal regimen remains unresolved, with acceptable dosing options of 1 g IV/IO followed by 1 g over 8 hours, or 2 g IV/IO infusion/slow push. Pediatric data are insufficient, with no standardized dosing. Overall, there was no benefit of TXA beyond 3 hours, and <90 minutes may be ideal.
As a consensus statement synthesizing heterogeneous prehospital studies, this review lacks uniform RCT-level data, precise effect sizes, pediatric data, and definitive dosing/timing protocols, limiting generalizability across diverse EMS systems.
How will this change my practice?
TXA is currently being used widely throughout Clark County (Las Vegas) where I work, and we receive many patients who receive TXA prior to arrival to our Level 1 trauma center. As an EMS director and physician in such a facility, this helps scaffold policies and protocols advocating for early use of TXA in the traumatic shock patient, with an emphasis on clear communication of administration at handoff to avoid double dosing.
Source
Tranexamic acid in trauma: A joint position statement and resource document of NAEMSP, ACEP, and ACS-COT. J Trauma Acute Care Surg. 2025 Sep 1;99(3):357-363. doi: 10.1097/TA.0000000000004727. Epub 2025 Aug 18. PMID: 40842057; PMCID: PMC12363306.
