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# Tranexamic Acid
## Overview
Tranexamic acid (TXA) is a synthetic lysine analog that competitively inhibits the activation of plasminogen to plasmin, thereby preventing fibrinolysis and stabilizing clot formation.
## Primary Indications
* Treatment/prevention of hemorrhage (trauma, surgical, or dental).
* Heavy menstrual bleeding (menorrhagia).
* Hereditary angioedema (prophylaxis).
## Adult Dosing
* **Trauma (CRASH-2 protocol):** 1 g IV loading dose over 10 minutes, followed by 1 g IV infusion over 8 hours.
* **Heavy Menstrual Bleeding:** 1.3 g orally three times daily (max 5 days per cycle).
* **Surgery (Cardiac/Orthopedic):** Highly variable; common regimens include 10–20 mg/kg loading dose, followed by 1–10 mg/kg/hr infusion. Consult local institutional protocols.
## Pediatric Dosing
* **Trauma:** 15 mg/kg IV loading dose (max 1 g), followed by 2 mg/kg/hr infusion (max 1 g/hr for up to 8 hours).
* **Off-label/Surgical:** Dosing is highly protocol-dependent; ranges 10–25 mg/kg are common but must be verified by pediatric-specific institutional guidelines.
## Dose Adjustments
* **Renal Impairment:** Adjust dose in renal failure (CrCl <50 mL/min).
* CrCl 30–50 mL/min: Reduce dose or increase interval.
* Example: 1 g every 12–24 hours.
* **Hepatic Impairment:** No specific adjustment required.
## Contraindications
* Active intravascular clotting (thrombosis/embolism/history of DVT or PE).
* Subarachnoid hemorrhage (due to risk of cerebral ischemia/seizure).
* Color vision disorders (acquired dyschromatopsia).
* Hypersensitivity to TXA.
## Adverse Effects
* **Gastrointestinal:** Nausea, vomiting, diarrhea (worse with oral administration).
* **Neurological:** Seizures (especially with rapid IV injection or high doses).
* **Thromboembolic:** Increased risk of venous/arterial thrombosis.
* **Ocular:** Visual disturbances (rare).
## Key Drug Interactions
* **Estrogens/Oral Contraceptives:** Concomitant use with TXA may increase risk of thrombosis.
* **Thrombolytics:** Antagonizes effect; avoid concomitant use.
* **Prothrombin Complex Concentrates (PCC):** Theoretical increased risk of thrombosis.
## Monitoring
* **Safety:** Monitor for signs of DVT/PE (leg swelling, chest pain, dyspnea).
* **Neurological:** Observe for seizure activity, particularly during high-dose rapid infusion.
* **Renal:** Monitor serum creatinine and urine output.
## Clinical Pearls
* **Infusion Safety:** Do not administer rapidly IV; rate of injection must not exceed 1 mL/min to prevent hypotension or seizures.
* **Efficacy:** Effectiveness is significantly diminished if administered >3 hours after a traumatic injury.
* **Stability:** Once diluted for IV infusion, use promptly; discard unused portions according to institutional policy.
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*Disclaimer: This information is for educational purposes only. Dosing, contraindications, and clinical protocols vary by institution, updated guidelines, and specific clinical settings. Always verify prescribing information and facility-specific protocols before administration.*
