TXA & anticoagulant/antiplatelet reversal

South East Scotland Major Trauma Guidelines
NHS Lothian

Please also refer to the findings of the CRASH 2 Trial,

published by Health Technology Assessment.

Tranexamic acid

The following adults should receive 1g TXA *:
      -at risk of bleeding or with confirmed bleeding and a HR >110 and/or SBP <90mmHg 
      -GCS<13 with evidence of a head injury 
Give a further 1g bolus if there is:
      -  bleeding requiring ongoing resuscitation and/or haemorrhage control
      - confirmed intracranial haemorrhage in patients with GCS <13
        - hyperfibrinolysis on viscoelastic studies
 
 
*Do not give first dose of TXA >3hours from injury unless evidence of hyperfibrinolysis. 
The maximum total dose is 2g. 
Where all criteria are met it may be appropriate to administer a 2g bolus.  

Paediatric tranexamic acid

Tranexamic Acid (TXA) can be administered to paediatrics within 3 hours of injury if the child requires RCC transfusion or is considered to be at major risk or bleeding especially if managed conservatively.

Dose for paediatrics is 15mg/kg up to a maximum of 1g.

Local guidance for RHCYP Edinburgh

Indication: to be administered within 3 hours of injury to:

  • Any child who requires RCC transfusion within 3 hrs of injury.
  • Any child considered (by the treating clinician) to be at significant risk of major bleeding (e.g. liver lac, splenic lac), especially if being managed conservatively.

Dosage:

  • Loading dose – 15mg/kg (max 1g) diluted in a convenient volume of sodium chloride 0.9% or glucose 5% and given over 10 minutes.
  • Maintenance infusion – 2mg/kg/hour.  Suggested dilution 500mg in 500ml of sodium chloride 0.9% or glucose 5% given at a rate of 2mls/kg/hour.  For at least 8 hours or until bleeding stops.

Reference

Evidence statement: Major trauma and the use of tranexamic acid in children, RCPCH, November 2012.

Anticoagulant / antiplatelet reversal

  • An INR and an APTTR of ≤1excludes the presence of significant levels of novel anticoagulants in most patients.
  • Patients on warfarin should be reversed unless the bleed is extremely small and the procoagulation risk is high.
  • Reversal should occur within one hour of decision to reverse.
  • Please refer to local guidelines for warfarin/NOAC reversal policies

Advanced age is not an absolute predictor of poor outcomes following trauma and should not be used as the sole criterion for denying or limiting care.

 

 

Managing patients who refuse blood (including Jehovah’s Witnesses)

Resources for managing patients who refuse blood (including Jehovah’s Witnesses) is available from NHS Lothian Policy Online.

Antithrombotic reversal in TBI or traumatic haemorrhage

Please also refer to Antithrombotic guidelines.

Editorial Information

Last reviewed: 01/09/2021

Next review date: 01/09/2024

Version: 1.0