In major trauma with significant or suspected haemorrhage, give tranexamic acid as soon as possible and within three hours of injury, because the mortality benefit is time-critical and is lost, and may reverse, when given later.
Start it before or alongside other resuscitation rather than waiting for laboratory confirmation of coagulopathy, and give it prehospital where that is possible. It complements, and does not replace, haemorrhage control and balanced blood-product resuscitation.
- Give tranexamic acid within three hours of major traumatic haemorrhage.
- Do not wait for lab confirmation of coagulopathy to start it.
- Give it prehospital when that is feasible, as benefit is time-critical.
- It supplements, not replaces, haemorrhage control and blood-product resuscitation.
Why it matters
The survival benefit of tranexamic acid depends on how early it is given, so delay erodes it.
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