Please check your internet connection and try again.
# Tranexamic Acid
## Overview
Tranexamic acid (TXA) is a synthetic antifibrinolytic agent that competitively inhibits the activation of plasminogen to plasmin, thereby preventing the breakdown of fibrin clots.
## Primary Indications
* **Trauma:** Adjunct for hemorrhage control in significant trauma (CRASH-2 protocol).
* **Surgery:** Reduction of blood loss in orthopedic, cardiac, and spinal surgeries.
* **Obstetrics:** Management of postpartum hemorrhage (WOMAN trial).
* **Menorrhea:** Treatment of heavy menstrual bleeding.
* **Dental/Surgical Procedures:** Adjunct in patients with coagulopathies.
## Adult Dosing
* **Trauma/Acute Hemorrhage:** 1 g IV bolus followed by 1 g IV infusion over 8 hours. Administer within 3 hours of injury.
* **Postpartum Hemorrhage:** 1 g IV bolus; if bleeding continues after 30 minutes or recurs within 24 hours, a second 1 g dose may be administered.
* **Heavy Menstrual Bleeding:** 1.3 g orally three times daily for up to 5 days during menstruation.
* **Surgical Hemorrhage:** Dosing varies widely by facility and procedure (often 10–20 mg/kg IV pre-operatively).
## Pediatric Dosing
* **Trauma (Off-label):** 15 mg/kg (max 1 g) IV bolus, followed by 2 mg/kg/hour (max 1 g/hr) infusion for 8 hours.
* **Surgical Prophylaxis/Cardiac:** Dosing ranges from 10–100 mg/kg depending on institution-specific cardiac protocols.
## Dose Adjustments
* **Renal Impairment:** Requires significant dose reduction (e.g., 50–75% reduction in CrCl < 50 mL/min). Clinical guidelines vary; consultation with a pharmacist or nephrologist is recommended.
* **Hepatic Impairment:** No standard adjustment required, but use with caution.
## Contraindications
* Hypersensitivity to the drug.
* Active thromboembolic disease (DVT, PE, cerebral thrombosis).
* History of acquired disturbances of color vision.
* Active intravascular clotting.
* Subarachnoid hemorrhage (due to risk of cerebral ischemia/seizure).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, headache.
* **Serious:** Thromboembolic events (PE, DVT, MI, stroke), seizures (particularly with high-dose/neuraxial administration), hypersensitivity reactions, visual disturbances.
## Key Drug Interactions
* **Factor IX complex/Prothrombin complex concentrates:** High risk of thrombotic complications; avoid concomitant use.
* **Hormonal Contraceptives:** Potential increased risk of venous thromboembolism (VTE).
* **Thrombolytics:** Antagonizes the effects of agents like tPA/alteplase.
## Monitoring
* **Clinical:** Neurological status, signs of thromboembolism (calf pain, shortness of breath, chest pain), blood pressure.
* **Baseline/Ongoing:** In patients with renal dysfunction, monitor serum creatinine. Visual exams if prolonged use is planned.
## Clinical Pearls
* **Seizure Risk:** Avoid rapid IV injection. Rapid administration can trigger seizures, particularly in cardiac surgery patients.
* **Not a Replacement:** TXA stabilizes existing clots; it does not replace source control (surgery, sutures, or hemodynamic resuscitation).
* **Timing:** For trauma, efficacy drops significantly if administered >3 hours post-injury.
* **Avoid Neuraxial/Intrathecal:** Never administer TXA via the spinal route (e.g., epidural/intraspinal) as it is highly neurotoxic and can be fatal.
***
*Disclaimer: This information is for educational purposes only. Dosing protocols may vary significantly by institution and patient-specific factors. Always verify current prescribing information, institutional protocols, and specific product labeling (e.g., package inserts) before prescribing or administering medication.*
