title: Addition of tranexamic acid to a traumatic injury massive transfusion protocol.
abstract: OBJECTIVE
  The development of eligibility criteria and use of tranexamic acid in conjunction with a massive transfusion protocol (MTP) are described.
  
  
  CONCLUSIONS
  The trauma surgery and pharmacy departments collaborated to operationalize tranexamic acid administration in trauma patients for whom an MTP was activated. The MTP at Boston Medical Center, an urban, tertiary, academic medical center, is activated by the attending physician when the patient is expected to require at least 10 units of packed red blood cells in 24 hours. Tranexamic acid was considered in MTP trauma patients who arrived at the medical center within 8 hours of traumatic injury, were 15 years of age or older, and weighed at least 40 kg. Eligible patients were to receive a loading dose of tranexamic acid 1 g i.v. over 10 minutes followed by a maintenance dose of 1 g infused over 8 hours. To ensure that tranexamic acid use was limited to trauma patients, both its location of use and physician-ordering privileges were restricted by the pharmacy department. A 16-month assessment revealed that 16 patients received tranexamic acid, 13 (81%) of whom met all criteria for use. Tranexamic acid was used in 13 (38%) of 34 eligible MTP patients. Barriers to the use of tranexamic acid include a lack of familiarity with the medication among staff, drug availability, the complexity of administration, and the critical setting of MTP activation.
  
  
  CONCLUSIONS
  Multidisciplinary collaboration and standardization of tranexamic acid use in conjunction with an MTP promoted use of the drug within a trauma population.
authors.affiliation: Natalija M. Farrell, Pharm.D., BCPS, is Postgraduate Year 3 Clinical Toxicology Pharmacy Fellow, Georgia Poison Center, Atlanta. Heidi A. Wing is Trauma Data Manager, Boston Medical Center, Boston, MA. Peter A. Burke, M.D., FACS, is Chief of Trauma Services, Boston Medical Center, and Professor of Surgery, School of Medicine, Boston University, Boston. Paul Huiras, Pharm.D., BCPS, is Surgical Intensive Care Unit Clinical Pharmacy Specialist, Boston Medical Center.
authors.forename: Natalija M
authors.initials: NM
authors.lastname: Farrell
authors.affiliation: Natalija M. Farrell, Pharm.D., BCPS, is Postgraduate Year 3 Clinical Toxicology Pharmacy Fellow, Georgia Poison Center, Atlanta. Heidi A. Wing is Trauma Data Manager, Boston Medical Center, Boston, MA. Peter A. Burke, M.D., FACS, is Chief of Trauma Services, Boston Medical Center, and Professor of Surgery, School of Medicine, Boston University, Boston. Paul Huiras, Pharm.D., BCPS, is Surgical Intensive Care Unit Clinical Pharmacy Specialist, Boston Medical Center.
authors.forename: Heidi A
authors.initials: HA
authors.lastname: Wing
authors.affiliation: Natalija M. Farrell, Pharm.D., BCPS, is Postgraduate Year 3 Clinical Toxicology Pharmacy Fellow, Georgia Poison Center, Atlanta. Heidi A. Wing is Trauma Data Manager, Boston Medical Center, Boston, MA. Peter A. Burke, M.D., FACS, is Chief of Trauma Services, Boston Medical Center, and Professor of Surgery, School of Medicine, Boston University, Boston. Paul Huiras, Pharm.D., BCPS, is Surgical Intensive Care Unit Clinical Pharmacy Specialist, Boston Medical Center.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Burke
authors.affiliation: Natalija M. Farrell, Pharm.D., BCPS, is Postgraduate Year 3 Clinical Toxicology Pharmacy Fellow, Georgia Poison Center, Atlanta. Heidi A. Wing is Trauma Data Manager, Boston Medical Center, Boston, MA. Peter A. Burke, M.D., FACS, is Chief of Trauma Services, Boston Medical Center, and Professor of Surgery, School of Medicine, Boston University, Boston. Paul Huiras, Pharm.D., BCPS, is Surgical Intensive Care Unit Clinical Pharmacy Specialist, Boston Medical Center. paul.huiras@bmc.org.
authors.forename: Paul
authors.initials: P
authors.lastname: Huiras
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D001900:Boston; D003299:Cooperative Behavior; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D014148:Tranexamic Acid / Q000008:administration & dosage*; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid