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# 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 the breakdown of fibrin clots. ## Primary Indications * Treatment/prevention of excessive bleeding (surgical, trauma, obstetric). * Heavy menstrual bleeding. * 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. Ideally administered within 3 hours of injury. * **Postpartum Hemorrhage (WOMAN trial protocol):** 1 g IV over 10 minutes. If bleeding continues after 30 minutes, may administer a second 1 g IV dose. * **Heavy Menstrual Bleeding:** 1.3 g orally three times daily for up to 5 days during menstruation. * **Surgical Hemorrhage:** Dosing is highly protocol-dependent; 10–15 mg/kg IV or fixed doses (e.g., 1 g) are common. ## Pediatric Dosing * **Trauma/Emergency Hemorrhage:** 15 mg/kg (max 1 g) IV loading dose, followed by 2 mg/kg/hour infusion until bleeding is controlled or up to 8 hours. * **Note:** Dosing in pediatrics varies significantly by institution; consult local pediatric clinical pathways. ## Dose Adjustments * **Renal Impairment:** Requires dose reduction or longer dosing intervals in moderate-to-severe renal impairment (CrCl < 50 mL/min) to prevent drug accumulation and risk of convulsions. * **Hepatic Impairment:** No specific adjustment required. ## Contraindications * Active intravascular clotting (thromboembolic disease). * History of venous or arterial thrombosis (unless risk is outweighed by benefit). * Acquired color vision disturbances (prevents monitoring for retinal toxicity). * Subarachnoid hemorrhage (theoretical risk of cerebral vasospasm). ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal pain. * **Serious:** Thromboembolic events (DVT, PE, MI, stroke), seizures (observed with high IV doses or rapid administration), and visual disturbances. ## Key Drug Interactions * **Factor IX complex concentrates/Prothrombin complex concentrates:** Increased risk of thrombotic complications; avoid concomitant use. * **Hormonal contraceptives:** Theoretical increased risk of thrombosis when used concurrently. ## Monitoring * Monitor for signs of venous or arterial thrombosis (pain/swelling in extremities, chest pain, dyspnea). * Neurological status (risk of seizure if dose exceeds guidelines). * Renal function (BUN/SCr) in patients on chronic therapy or those with renal impairment. ## Clinical Pearls * **Rapid Administration:** IV bolus administration exceeding 100 mg/min may induce hypotension or dizziness. * **Oral vs. IV:** Oral formulations are strictly for heavy menstrual bleeding; do not interchange with parental formulations for systemic hemorrhage. * **Incompatibility:** Avoid mixing with blood products or penicillin in intravenous solutions. *** *Disclaimer: This information is for educational purposes and does not substitute professional medical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors before administration.*