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 competitively inhibiting the activation of plasminogen to plasmin, thereby preventing fibrin degradation.
## Primary Indications
* **Trauma:** Adjunct in management of severe hemorrhage to reduce mortality (CRASH-2/MATTERS protocols).
* **Postpartum Hemorrhage (PPH):** Treatment of hemorrhage following childbirth.
* **Surgical Hemorrhage:** Reduction of blood loss during orthopedic, cardiac, or spinal surgery.
* **Menorrhagia:** Short-term management of heavy menstrual bleeding.
* **Epistaxis/Dental extraction:** Topical or systemic management of localized bleeding.
## Adult Dosing
* **Trauma/PPH:** 1 gram IV bolus, followed by 1 gram IV infusion over 8 hours. Administer as soon as possible, ideally within 3 hours of injury.
* **Menorrhagia:** 1.3 grams orally three times daily for up to 5 days during menstruation.
* **Prophylaxis (Surgical):** Dose varies significantly by institutional protocol (typically 10–30 mg/kg IV).
## Pediatric Dosing
* **Trauma/Hemorrhage:** 15 mg/kg IV loading dose (max 1g), followed by 2 mg/kg/hour infusion (max 1g/hour) for up to 8 hours.
* *Note: Dosing is often extrapolated from adult trauma trials; consult institutional guidelines for specific pediatric protocols.*
## Dose Adjustments
* **Renal Impairment:** Requires dose reduction in severe renal impairment (CrCl <50 mL/min). If CrCl 30–50 mL/min, reduce dose by half or increase interval. If CrCl <30 mL/min, use with extreme caution; frequent monitoring required.
## Contraindications
* Hypersensitivity to TXA.
* Active intravascular clotting (thromboembolic disease).
* Acquired defective color vision (prevents monitoring of retinal toxicity).
* Subarachnoid hemorrhage (risk of cerebral ischemia/convulsions).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, headache.
* **Serious:** Thromboembolic events (DVT, PE, MI, stroke), seizures (particularly with high doses or rapid IV administration), visual color changes, retinal venous/arterial occlusion.
## Key Drug Interactions
* **Procoagulants/Estrogens:** Potential increased risk of thrombosis when combined with hormonal contraceptives or Factor IX complex concentrates.
* **Thrombolytics:** Antagonistic effect; do not use concurrently.
## Monitoring
* **Clinical:** Monitor for signs of thromboembolism (leg pain, chest pain, dyspnea, neurological deficits).
* **Ophthalmological:** Periodic eye exams if long-term treatment is initiated.
* **Renal:** Monitor serum creatinine/BUN in patients with known renal impairment.
## Clinical Pearls
* **Administration:** Administer IV push slowly to prevent hypotension and potential seizures.
* **Timing:** Efficacy is highly time-dependent; clinical benefit diminishes significantly if administered >3 hours post-trauma.
* **Off-label:** Often utilized as a topical rinse (e.g., in mouthwash or surgical site irrigation) to manage localized bleeding with minimal systemic absorption.
***
**Educational Disclaimer:** This information is for educational purposes only. Clinical practice protocols vary by institution. Always verify dosages, contraindications, and drug compatibility against your current hospital formulary, electronic health record system, or the official FDA-approved prescribing information before administration.
