Please check your internet connection and try again.
# Tranexamic Acid
## Overview
Tranexamic acid (TXA) is a synthetic lysine analog that acts as an antifibrinolytic agent by reversibly blocking lysine-binding sites on plasminogen, preventing its conversion to plasmin. This inhibits fibrin degradation, thereby stabilizing clots.
## Primary Indications
* **Trauma-associated hemorrhage:** Management of severe bleeding (CRASH-2 protocol).
* **Postpartum hemorrhage (PPH):** Treatment of uterine bleeding.
* **Menorrhagia:** Short-term management of cyclic heavy menstrual bleeding.
* **Surgical prophylaxis:** Reduction of blood loss in orthopedic, cardiac, and dental procedures (especially in patients with coagulopathies).
## Adult Dosing
* **Trauma/PPH:** 1 g IV bolus over 10 minutes, followed by an infusion of 1 g over 8 hours (or 1 g IV every 8 hours). Administer as soon as possible, ideally within 3 hours of injury.
* **Menorrhagia:** 1.3 g orally three times daily for a maximum of 5 days during menstruation.
* **Surgical Hemorrhage:** Highly protocol-dependent; ranges from 10–20 mg/kg IV bolus pre-procedure, sometimes followed by infusion.
## Pediatric Dosing
* **Trauma (Off-label/CRASH-2 extrapolated):** 15 mg/kg IV bolus (max 1 g), followed by 2 mg/kg/hour infusion for up to 8 hours.
* **Consult local pediatric institutional protocols** for specific surgical or hemophilia-related dosing, as weight-based requirements vary significantly by clinical setting.
## Dose Adjustments
* **Renal Impairment:** Requires dose reduction or longer dosing intervals.
* CrCl 30–50 mL/min: 10 mg/kg IV twice daily.
* CrCl 10–29 mL/min: 10 mg/kg IV once daily.
* CrCl <10 mL/min: 10 mg/kg IV every 48 hours.
* **Hepatic Impairment:** No specific adjustment required.
## Contraindications
* **Active intravascular clotting:** Known history of DVT, pulmonary embolism, or cerebral thrombosis.
* **Subarachnoid hemorrhage:** Risk of cerebral ischemia.
* **Color vision disturbance:** Acquired defective color vision (prevents monitoring potential retinal toxicity).
* **Hypersensitivity:** Known allergy to TXA.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Thromboembolic events (DVT, PE, stroke, MI), seizures (risk increases with rapid IV infusion or high cumulative doses), and retinal artery/vein occlusion.
## Key Drug Interactions
* **Combined Hormonal Contraceptives:** May increase the risk of thrombosis if used concurrently.
* **Thrombolytics/Factor IX Complex:** Concurrent use may counteract the therapeutic effect of thrombolytic agents or increase prothrombotic risk.
## Monitoring
* **Neurological:** Monitor for seizure activity, especially in patients with a history of epilepsy.
* **Vascular:** Monitor for signs of DVT/PE (pain, swelling, respiratory distress).
* **Renal:** Monitor serum creatinine and urine output to determine dosing adjustments.
* **Ocular:** Baseline and periodic ophthalmologic exams for long-term therapy.
## Clinical Pearls
* **Administration Safety:** Do not exceed 100 mg/min for IV bolus administration to avoid hypotension and risk of seizures.
* **Oral Formulations:** TXA PO should be swallowed whole; do not crush or chew.
* **Time Sensitivity:** In trauma, the efficacy of TXA significantly declines if administered more than 3 hours after the initial injury.
* **Cost/Availability:** Formulation availability (oral vs. IV) vary widely by geographic region and institutional formulary.
***
**Educational Disclaimer:** This information is for educational purposes only. Clinical guidelines and dosing protocols vary by institution and patient status. Always verify current prescribing information, institutional protocols, and contraindications before administering medication.
