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Delayed tranexamic acid decision — DipIMC MCQ

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HardPre-hospital PharmacologyDelayed tranexamic acid decisionDipIMC

A 58-year-old man with major trauma has active bleeding and the injury occurred 4 hours ago. A crew member asks whether to give tranexamic acid now. What is the most appropriate drug/dose?

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Correct answer: E — Do not give pre-hospital tranexamic acid unless specialist advice indicates hyperfibrinolysis

NICE recommends IV tranexamic acid as soon as possible in major trauma with active or suspected bleeding but not more than 3 hours after injury unless there is evidence of hyperfibrinolysis. Giving it late without indication may be harmful or unhelpful. Aspirin and empirical anticoagulant reversal do not address this scenario. The pearl is that TXA is time-critical, not a generic haemostatic tonic.

Reference: NICE Major Trauma NG39; JRCALC Guidelines 2025