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Tranexamic Acid in Trauma — FRCA Final MCQ

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ModerateTrauma & Emergency AnaesthesiaTranexamic Acid in TraumaFRCA Final

A 22-year-old man weighing 70 kg sustained a traumatic above-elbow amputation of his right arm in a factory accident 90 minutes ago. Despite tourniquet application and transfusion of 2 units of red cells he remains haemodynamically unstable with ongoing suspected major haemorrhage. His fibrinogen concentration is 1.2 g/L and there is no evidence of head injury. Which antifibrinolytic regimen should now be given?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Tranexamic acid 1 g IV over 10 minutes, then 1 g IV over 8 hours

Explanation lettering: E = shown as A · A = shown as B · D = shown as C · B = shown as D · C = shown as E

A is correct. NICE NG39 directs intravenous tranexamic acid as soon as possible in major trauma with active or suspected active bleeding, and not beyond 3 hours from injury unless hyperfibrinolysis is demonstrated; this patient is 90 minutes post-injury and still bleeding. The evaluated regimen is 1 g over 10 minutes followed by 1 g infused over 8 hours. Tranexamic acid is a lysine analogue that blocks plasminogen lysine-binding sites, preventing plasmin-mediated fibrin breakdown. B and C are not UK trauma practice: aminocaproic acid is a weaker analogue used mainly in cardiac surgery abroad, and aprotinin has no trauma indication. D omits the maintenance infusion and rapid bolus administration causes hypotension. E is wrong because hypofibrinogenaemia should be corrected concurrently (fibrinogen concentrate/cryoprecipitate) but never delays tranexamic acid, whose benefit falls with every minute.

Reference: NICE. Major trauma: assessment and initial management (NG39), Recommendations — haemorrhage/tranexamic acid, 2016 (current). https://www.nice.org.uk/guidance/ng39/chapter/recommendations