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Tranexamic Acid for Trauma Patients: A Critical Review of the Literature

Cap, Andrew P. MD, PhD; Baer, David G. PhD; Orman, Jean A. MPH, ScD; Aden, James PhD; Ryan, Kathy PhD; Blackbourne, Lorne H. MD

The Journal of Trauma: Injury, Infection, and Critical Care: July 2011 - Volume 71 - Issue 1 - p S9-S14
doi: 10.1097/TA.0b013e31822114af
Review Article

Background: Tranexamic acid (TXA) is an antifibrinolytic that inhibits both plasminogen activation and plasmin activity, thus preventing clot break-down rather than promoting new clot formation. TXA has been used around the world to safely control bleeding since the 1960s. A large randomized trial recently conducted in >20,000 trauma patients adds to the large body of data documenting the usefulness of TXA in promoting hemostasis.

Methods: We reviewed the literature describing use of TXA in a variety of settings including trauma.

Results: TXA has been safely used across a wide range of clinical settings to control hemorrhage. The results of a large, randomized, placebo-controlled trial support the use of TXA to treat bleeding trauma patients.

Conclusions: This inexpensive and safe drug should be incorporated into trauma clinical practice guidelines and treatment protocols. Further research on possible alternate mechanisms of action and dosing regimens for TXA should be undertaken. Concurrent to these endeavors, TXA should be adopted for use in bleeding trauma patients because it is the only drug with prospective clinical evidence to support this application.

From the U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas.

Submitted for publication April 18, 2011.

Accepted for publication April 22, 2011.

Supported by U.S. Army.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army or Department of Defense.

Address for reprints: Andrew P. Cap, MD, PhD, U.S. Army Institute of Surgical Research, Building, 3611 Fort Sam Houston, TX 78234; email:

© 2011 Lippincott Williams & Wilkins, Inc.