Category: Trauma
Keywords: TXA, EMS, prehospital, consensus (PubMed Search)
Posted: 9/14/2025 by Robert Flint, MD
(Updated: 12/5/2025)
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The National Association of EMS Physicians, the American College of Surgeons Committee on Trauma, and the American College of Emergency Physicians recommends:
• Prehospital TXA administration may reduce mortality in adult trauma patients with hemorrhagic shock when administered after lifesaving interventions.
• Prehospital TXA administration appears safe, with low risk of thromboembolic events or seizure.
• The ideal dose, rate, and route of prehospital administration of TXA for adult trauma patients with hemorrhagic shock has not been determined. Current evidence suggests EMS agencies may administer either a 1-g intravenous/intraosseous dose (followed by a hospital-based 1-g infusion over 8 hours) or a 2-g intravenous/intraosseous dose as an infusion or slow push.
• Prehospital TXA administration, if used for adult trauma patients, should be given to those with clinical signs of hemorrhagic shock and no later than 3 hours post-injury. There is no evidence to date to suggest improved clinical outcomes from TXA initiation beyond this time or in those without clinically significant bleeding.
• The role of prehospital TXA in pediatric trauma patients with clinical signs of hemorrhagic shock has not been studied, and standardized dosing has not been established. If used, it should be given within 3 hours of injury.
• Prehospital TXA administration, if used, should be clearly communicated to receiving health care professionals to promote appropriate monitoring and to avoid duplicate administration(s).
• A multidisciplinary team, led by EMS physicians, that includes EMS clinicians, emergency physicians, and trauma surgeons should be responsible for developing a quality improvement program to assess prehospital TXA administration for protocol compliance and identification of clinical complications.
Barrett, Whitney J. MD; Kaucher, Kevin A. PharmD, BCCCP; Orpet, Ross E. MD; Campion, Eric M. MD; Goodloe, Jeffrey M. MD; Fischer, Peter E. MD, MS, NRP; Colwell, Christopher B. MD; Lyng, John W. MD, NRP. Tranexamic acid in trauma: A joint position statement and resource document of NAEMSP, ACEP, and ACS-COT. Journal of Trauma and Acute Care Surgery 99(3):p 357-363, September 2025. | DOI: 10.1097/TA.0000000000004727
