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# Tranexamic Acid
## Overview
Tranexamic acid (TXA) is an antifibrinolytic agent that competitively inhibits the activation of plasminogen to plasmin, thereby preventing the breakdown of fibrin clots. It is used to manage or prevent hemorrhagic conditions.
## Primary Indications
* Trauma-related hemorrhage (CRASH-2 protocol).
* Postpartum hemorrhage.
* Heavy menstrual bleeding.
* Short-term management of cyclic heavy menstrual bleeding.
* Prophylaxis or treatment of hemorrhage in patients with hereditary angioedema or dental surgery in hemophilia.
## Adult Dosing
* **Trauma/Acute Hemorrhage:** 1 g IV loading dose over 10 minutes, followed by 1 g infusion over 8 hours. Administer as soon as possible, ideally within 3 hours of injury.
* **Heavy Menstrual Bleeding:** 1,300 mg orally three times daily (3,900 mg/day total) for up to 5 days during menstruation.
* **Dental Surgery (Hemophilia):** 10 mg/kg IV pre-operatively, then 25 mg/kg orally or IV 3–4 times daily for 2–8 days post-operatively.
## Pediatric Dosing
* **Trauma (Off-label/Protocol-dependent):** 15 mg/kg IV loading dose (max 1 g), followed by 2 mg/kg/hour infusion for up to 8 hours or until bleeding stops.
* *Note: Always verify local institutional trauma protocols for pediatric weight-based dosing and rates.*
## Dose Adjustments
* **Renal Impairment:** Dosage reduction is required for CrCl ≤ 50 mL/min.
* CrCl 30–50 mL/min: 50% of standard dose.
* CrCl 10–30 mL/min: 25% of standard dose.
* CrCl < 10 mL/min: 10% of standard dose.
* **Hepatic Impairment:** No specific adjustment necessary.
## Contraindications
* History of active thromboembolic disease (DVT, PE, cerebral thrombosis).
* Subarachnoid hemorrhage (due to risk of cerebral ischemia/convulsions).
* Known hypersensitivity to tranexamic acid.
* Color vision defects (prevents monitoring of toxic retinopathy).
## Adverse Effects
* **Common:** Headache, abdominal pain, back pain, musculoskeletal pain, fatigue.
* **Serious:** Venous or arterial thrombosis (MI, stroke, PE), seizure (high doses/rapid administration), color vision changes (retinal vein occlusion).
## Key Drug Interactions
* **Estrogens/Combined Hormonal Contraceptives:** Concomitant use increases the risk of thrombosis.
* **Factor IX complex concentrates/Antinhibitor coagulant complexes:** Increased risk of thrombotic events; avoid concomitant use.
* **Thrombolytics:** Concurrent use negates the effect of thrombolytic therapy.
## Monitoring
* Monitor for signs of thromboembolism (e.g., calf pain, shortness of breath, chest pain, vision changes).
* Periodic ophthalmic examinations are recommended with long-term use.
* Renal function (BUN/SCr) in patients with known impairment.
## Clinical Pearls
* **Seizure Risk:** Rapid IV injection can increase the risk of seizures; always administer over at least 10 minutes.
* **Timing:** For trauma, efficacy declines significantly if administered beyond 3 hours post-injury.
* **Administration:** Oral tablets should be swallowed whole and not crushed.
* **Dosing Uncertainty:** Dosing for specific off-label surgical or pediatric use varies significantly by local hospital policy; always consult an institutional pharmacist or clinical lead regarding specific trauma protocols.
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*Disclaimer: This information is for educational purposes and is not a substitute for professional medical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors before administration.*
