Intramuscular Administration of Tranexamic Acid (TXA)

Current Guideline Recommendations for TXA Administration

• The World Health Organization (WHO) recommends intravenous administration of TXA at a loading dose of 1 g infused over 10 minutes, followed by an IV infusion of 1 g over 8 hours 1, 2, 3
• TXA should be administered as soon as possible after injury or onset of bleeding, and within 3 hours, as effectiveness decreases by 10% for every 15-minute delay 1, 4
• The World Health Organization (WHO) and European guidelines explicitly state that their recommendations apply to giving the drug intravenously only, as the benefits and potential harms of other routes are considered a research priority 1, 5

Clinical Implications and Limitations

• Current clinical guidelines do not yet include specific recommendations for IM dosing of TXA, as human clinical trials comparing outcomes between IV and IM administration are lacking 1, 2, 3

Practical Recommendations

• The European guidelines recommend IV administration remains the recommended route for TXA at 1 g over 10 minutes, followed by 1 g over 8 hours 2, 4
• IM administration should still adhere to the 3-hour window from time of injury or onset of bleeding 1, 4