Reviewing the efficacy of intramuscular versus intravenous tranexamic acid
Journal of Paramedic Practice · 2025-07-02 · Systematic review
Abstract
Background: Trauma haemorrhage is the leading cause of preventable death. While intravenous (IV) tranexamic acid (TXA) has proved effective in trials, the 2017 Manchester Arena attack highlighted the need to explore prehospital intramuscular (IM) TXA. Aims: This review aims to assess the feasibility of IM TXA by examining common factors affecting the efficacy of prehospital IV TXA administration. Methods: To find all studies discussing the use of prehospital TXA, a systematic search of MEDLINE, PubMed and CINAHL and grey literature was conducted. From 382 articles screened, five met the inclusion criteria. Findings: Four barrier categories were found to impact the efficacy of prehospital IV TXA: presenting injuries; time to drug administration; the effectiveness of prehospital IV TXA; and underuse of IV TXA. Conclusion: There are barriers to the provision of prehospital IV TXA. IM TXA offers faster, easier administration and could be carried out by non-medical personnel using an autoinjector.
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Tags
Haemostatics · Intravenous access · Time intervals · Tranexamic acid
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