TXA in burn

Q: What is the 20:40 rule for the use of Tranexamic acid (TXA) in burn patients who require surgical excisions?

Answer: 

Evidence supports the use of TXA for patients who require burn wound excisions. It potentially reduces blood loss and transfusion requirements.

• Patients who require over 20% TBSA of burn wound excisions are usually given a gram bolus of TXA
• Patients who require over 40% TBSA of burn wound excisions are usually given a gram bolus of TXA, followed by a 1-gram drip over eight hours

Topical TXA, with or without epinephrine, can also be used during surgery, depending on the surgeon's preference.

*Total Body Surface Area

#burn

#surgical-critical-care

References:

1. Tapking C, Hundeshagen G, Kirchner M, Fischer S, Kneser U, Bliesener B. Tranexamic acid reduced blood transfusions in acute burn surgery: A retrospective case-controlled trial. Burns. 2022 May;48(3):522-528. doi: 10.1016/j.burns.2022.03.002. Epub 2022 Mar 16. PMID: 35339324.

2. Fijany AJ, Givechian KB, Zago I, et al. Tranexamic acid in burn surgery: A systematic review and meta-analysis. Burns 2023; 49:1249.

3. Hesamirostami M, Ramezanpour E, Asadpour-Sorkhkolaee H, Jamali A, Amini M, Moghaddam MR. The effect of tranexamic acid on blood loss after surgical excision in burn patients. Burns. 2025 Dec;51(9):107682. doi: 10.1016/j.burns.2025.107682. Epub 2025 Aug 25. PMID: 41109167.