A practical, evidence-based guide for front-line physicians on how to Treat the Bleed

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Tranexamic acid

Tranexamic acid (TXA) is an anti-fibrinolytic drug and should be administered as soon as possible.


  • TXA has been shown to reduce the rate of bleeding and improve survival rates in acute hemorrhage (in the settings of trauma and postpartum hemorrhage)
    • TXA does not reduce death from gastrointestinal (GI) bleeding and should not be used to treat upper or lower GI bleeding
  • Every 15-minute delay in time to administration of TXA decreases survival benefit by 10%
  • The dosage and infusion rate should be determined by the local institution


  • Dosing options include:
    • 1-g bolus followed by a second 1-g bolus 1 hour later
    • 1-g bolus followed by 1 g-infusion over subsequent 8 hours
    • 2-g bolus up front (suggested in resource-challenged locations, for centres transferring patient out, or where quality audits have shown that the second gram is frequently missed)

None of these dosing options have been compared head-to-head


  1. Callum JL, Yeh CH, Petrosoniak A, et al. A Regional Massive Hemorrhage Protocol Developed Through a Modified Delphi Technique. CMAJ Open. 2019;7(3):e546-561.
  2. CRASH-2 Trial Collaborators; Shakur H, Roberts I, Bautista R, et al. 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. 2010;376(9734):23-32.
  3. Gayet-Ageron A, Prieto-Merino D, Ker K, et al. Effect of Treatment Delay on the Effectiveness and Safety of Antifibrinolytics in Acute Severe Haemorrhage: A Meta-Analysis of Individual Patient-Level Data From 40 138 Bleeding Patients. Lancet. 2018;391(10116):125-132.
  4. HALT-IT Trial Collaborators. Effects of a High-Dose 24-h Infusion of Tranexamic Acid on Death and Thromboembolic Events in Patients With Acute Gastrointestinal Bleeding (HALT-IT): An International Randomised, Double-Blind, Placebo-Controlled Trial. Lancet. 2020;395(10241):1927-1936.
  5. Morrison JJ, Dubose JJ, Rasmussen TE, et al. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg. 2012;147(2):113-119.
  6. Woman Trial Collaborators. Effect of Early Tranexamic Acid Administration on Mortality, Hysterectomy, and Other Morbidities in Women With Post-Partum Haemorrhage (WOMAN): An International, Randomised, Double-Blind, Placebo-Controlled Trial. Lancet. 2017;389(10084):2105-2116.
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A practical, evidence-based guide for front-line physicians on how to treat acquired bleeding