Quiz: How much do you know about prehospital TXA?

Have you had the chance to utilize TXA in the field? Learn more about the practice and test your knowledge

Have you utilized tranexemic acid (TXA) in the prehospital setting? In EMS1 columnist Jonathan Lee's recent article, "Understanding TXA," he explains its role in the field and which patients could benefit, as well as which conditions specifically could be made worse by incorporating TXA. 

Read Lee's article, and then test your knowledge with a quiz. Be sure to add your score to the comments. 


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  1. Stansfield, R., Morris, D., & Jesulola, E. [2020]. The use of tranexamic acid [TXA] for the management of hemorrhage in trauma patients in the prehospital environment: literature review and descriptive analysis of principal themes. Shock53[3], 277-283.
  2. Nishida, T., Kinoshita, T., & Yamakawa, K. [2017]. Tranexamic acid and trauma-induced coagulopathy. Journal of Intensive Care5[1], 1-7.
  3. Morrison, J. J., Dubose, J. J., Rasmussen, T. E., & Midwinter, M. J. [2012]. Military application of tranexamic acid in trauma emergency resuscitation [MATTERs] study. Archives of surgery147[2], 113-119.
  4. Roberts, I., Shakur, H., Coats, T., Hunt, B., Balogun, E., Barnetson, L., Cook, L., Kawahara, T., Perel, P., Prieto-Merino, D., Ramos, M., Cairns, J., & Guerriero, C. [2013]. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health technology assessment [Winchester, England]17[10], 1–79. https://doi.org/10.3310/hta17100
  5. Guyette, F. X., Brown, J. B., Zenati, M. S., Early-Young, B. J., Adams, P. W., Eastridge, B. J., ... & STAAMP Study Group. [2021]. Tranexamic acid during prehospital transport in patients at risk for hemorrhage after injury: a double-blind, placebo-controlled, randomized clinical trial. JAMA surgery156[1], 11-20.
  6. Fischer, P. E., Bulger, E. M., Perina, D. G., Delbridge, T. R., Gestring, M. L., Fallat, M. E., ... & Sanddal, N. D. [2016]. Guidance document for the prehospital use of tranexamic acid in injured patients. Prehospital Emergency Care20[5], 557-559.
  7. Shakur, H., Roberts, I., Fawole, B., Chaudhri, R., El-Sheikh, M., Akintan, A., ... & Loto, O. [2017]. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage [WOMAN]: an international, randomised, double-blind, placebo-controlled trial. The Lancet389[10084], 2105-2116.
  8. World Health Organization. [‎2017]‎. WHO recommendation on tranexamic acid for the treatment of postpartum haemorrhage. World Health Organization. https://apps.who.int/iris/handle/10665/259374. License: CC BY-NC-SA 3.0 IGO
  9. CRASH, T. [2019]. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury [CRASH-3]: a randomised, placebo-controlled trial. The Lancet394[10210], 1713-1723.
  10. Rowell, S. E., Meier, E. N., McKnight, B., Kannas, D., May, S., Sheehan, K., Bulger, E. M., Idris, A. H., Christenson, J., Morrison, L. J., Frascone, R. J., Bosarge, P. L., Colella, M. R., Johannigman, J., Cotton, B. A., Callum, J., McMullan, J., Dries, D. J., Tibbs, B., Richmond, N. J., … Schreiber, M. A. [2020]. Effect of Out-of-Hospital Tranexamic Acid vs Placebo on 6-Month Functional Neurologic Outcomes in Patients With Moderate or Severe Traumatic Brain Injury. JAMA324[10], 961–974. https://doi.org/10.1001/jama.2020.8958
  11. Baharoglu MI, Germans MR, Rinkel GJ, Algra A, Vermeulen M, van Gijn J, Roos YB. Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2013 Aug 30;2013[8]:CD001245. doi: 10.1002/14651858.CD001245.pub2. PMID: 23990381; PMCID: PMC8407182.
  12. Bouillon-Minois, J. B., Croizier, C., Baker, J. S., Pereira, B., Moustafa, F., Outrey, J., ... & Dutheil, F. [2021]. Tranexamic acid in non-traumatic intracranial bleeding: a systematic review and meta-analysis. Scientific Reports11[1], 1-10.
  13. Post, R., Germans, M. R., Tjerkstra, M. A., Vergouwen, M., Jellema, K., Koot, R. W., Kruyt, N. D., Willems, P., Wolfs, J., de Beer, F. C., Kieft, H., Nanda, D., van der Pol, B., Roks, G., de Beer, F., Halkes, P., Reichman, L., Brouwers, P., van den Berg-Vos, R. M., Kwa, V., … ULTRA Investigators [2021]. Ultra-early tranexamic acid after subarachnoid haemorrhage [ULTRA]: a randomised controlled trial. Lancet [London, England]397[10269], 112–118. https://doi.org/10.1016/S0140-6736[20]32518-6
  14. Roberts, I., Shakur-Still, H., Afolabi, A., Akere, A., Arribas, M., Brenner, A., ... & McClelland, L. [2020]. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding [HALT-IT]: an international randomised, double-blind, placebo-controlled trial. The Lancet395[10241], 1927-1936.
  15. Calapai, G., Gangemi, S., Mannucci, C., Minciullo, P. L., Casciaro, M., Calapai, F., ... & Navarra, M. [2015]. Systematic review of tranexamic acid adverse reactions. Journal of Pharmacovigilance2015.
  16. Cai, J., Ribkoff, J., Olson, S., Raghunathan, V., Al‐Samkari, H., DeLoughery, T. G., & Shatzel, J. J. [2020]. The many roles of tranexamic acid: an overview of the clinical indications for TXA in medical and surgical patients. European journal of haematology104[2], 79-87.

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