Tranexamic acid use in head injury

Last edited 05/2023 and last reviewed 06/2023

Tranexamic acid use in head injury

  • for people with a head injury and a GCS score of 12 or less who are not thought to have active extracranial bleeding, consider (1):
    • a 2 g intravenous bolus injection of tranexamic acid for people 16 and over
    • a 15 mg/kg to 30 mg/kg (up to a maximum of 2 g) intravenous bolus injection of tranexamic acid for people under 16

    • give the tranexamic acid as soon as possible within 2 hours of the injury, in the pre-hospital or hospital setting and before imaging

  • the NICE committee state:
    • people over 16
      • "..despite the uncertainty in the clinical evidence, there was a benefit with tranexamic acid in terms of reducing all-cause mortality and mortality from traumatic brain injury. They also considered that the evidence showed that it caused very few adverse events. Based on the evidence, they agreed that a 2 g intravenous bolus dose of tranexamic acid, given within 2 hours of a head injury and before imaging, could be considered for people 16 and over with moderate or severe traumatic brain injury. The committee recommended a 2 g intravenous bolus injection of tranexamic acid because this dose was found to be the most safe and effective.."
    • people under 16
      • "..Because of a lack of trial evidence for tranexamic use in people under 16, the committee used extrapolated evidence from the trials in adults, and their expertise and knowledge. In NHS clinical practice, a tranexamic acid dose of 15 mg/kg is used in people under 16 with extracranial injuries. But, in this age group, tranexamic acid is not currently widely used for isolated head injury and dosing is variable (15 mg/kg to 30 mg/kg). Evidence for people 16 and over with a head injury from a pre-hospital setting suggested that a 2 g dose of tranexamic acid reduced all-cause mortality (at 28 days and 6 months), with no evidence of negative effects. So, the committee concluded that it could recommend the equivalent of a 2 g dose of tranexamic acid for people under 16. They discussed that, based on the average weight of people 16 and over being 70 kg, a 2 g dose of tranexamic acid for people 16 and over would equate to a 30 mg/kg dose for people under 16. So, they concluded that a dose range of 15 mg/kg to 30 mg/kg was appropriate for people under 16.."

  • this recommendation for the early administration of tranexamic acid in people who have experienced a head injury with significant impairment of consciousness
    • aims to reduce morbidity and mortality, even in the absence of suspected extracranial bleeding
    • consider an intravenous tranexamic acid bolus within 2 hours of injury in people with suspected moderate or severe traumatic brain injury, even when no extracranial bleeding is evident (2)

Reference:

Related pages:

head injury