for people with a head injury and a GCS score of 12 or less who are not thought to have active extracranial bleeding, consider (1):
a 2 g intravenous bolus injection of tranexamic acid for people 16 and over
a 15 mg/kg to 30 mg/kg (up to a maximum of 2 g) intravenous bolus injection of tranexamic acid for people under 16
give the tranexamic acid as soon as possible within 2 hours of the injury, in the pre-hospital or hospital setting and before imaging
the NICE committee state:
people over 16
"..despite the uncertainty in the clinical evidence, there was a benefit with tranexamic acid in terms of reducing all-cause mortality and mortality from traumatic brain injury. They also considered that the evidence showed that it caused very few adverse events. Based on the evidence, they agreed that a 2 g intravenous bolus dose of tranexamic acid, given within 2 hours of a head injury and before imaging, could be considered for people 16 and over with moderate or severe traumatic brain injury. The committee recommended a 2 g intravenous bolus injection of tranexamic acid because this dose was found to be the most safe and effective.."
people under 16
"..Because of a lack of trial evidence for tranexamic use in people under 16, the committee used extrapolated evidence from the trials in adults, and their expertise and knowledge. In NHS clinical practice, a tranexamic acid dose of 15 mg/kg is used in people under 16 with extracranial injuries. But, in this age group, tranexamic acid is not currently widely used for isolated head injury and dosing is variable (15 mg/kg to 30 mg/kg). Evidence for people 16 and over with a head injury from a pre-hospital setting suggested that a 2 g dose of tranexamic acid reduced all-cause mortality (at 28 days and 6 months), with no evidence of negative effects. So, the committee concluded that it could recommend the equivalent of a 2 g dose of tranexamic acid for people under 16. They discussed that, based on the average weight of people 16 and over being 70 kg, a 2 g dose of tranexamic acid for people 16 and over would equate to a 30 mg/kg dose for people under 16. So, they concluded that a dose range of 15 mg/kg to 30 mg/kg was appropriate for people under 16.."
this recommendation for the early administration of tranexamic acid in people who have experienced a head injury with significant impairment of consciousness
aims to reduce morbidity and mortality, even in the absence of suspected extracranial bleeding
consider an intravenous tranexamic acid bolus within 2 hours of injury in people with suspected moderate or severe traumatic brain injury, even when no extracranial bleeding is evident (2)
Rajesh S, Wonderling D, Bernstein I, Balson C, Lecky F. Head injury: assessment and early management-summary of updated NICE guidance BMJ 2023; 381 :p1130 doi:10.1136/bmj.p1130
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