In a polytrauma patient with ongoing haemorrhage who meets criteria for tranexamic acid administration, what is the correct dosing regimen?
- A 1 gram IV bolus followed by 1 gram infused over 8 hours ✓
- B 500 mg IV bolus followed by 500 mg over 4 hours
- C 2 grams IV bolus as a single dose
- D 1 gram orally repeated every 6 hours for 24 hours
Correct answer: A. 1 gram IV bolus followed by 1 gram infused over 8 hours
Explanation
Tranexamic acid is given as a loading dose of 1 gram intravenously over 10 minutes, followed by an infusion of 1 gram over the next 8 hours. Benefit is greatest when started within 3 hours of injury, and it is harmful if given beyond that window. Lower doses were never tested in the major trials, and oral dosing has no role in the shocked bleeding patient. This regimen applies to both the CRASH-2 and military MATTERs experience.
Reference: ATLS Student Course Manual, American College of Surgeons, 10th ed.
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