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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 fibrin clot dissolution.
## Primary Indications
* Treatment or prevention of hemorrhage due to systemic hyperfibrinolysis or local fibrinolysis (e.g., trauma, surgical hemorrhage).
* Heavy menstrual bleeding.
* Hereditary angioedema (prophylaxis).
## Adult Dosing
* **Trauma-related hemorrhage:** 1 g IV bolus over 10 minutes, followed by 1 g IV 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 for up to 5 days during menstruation.
* **Surgical prophylaxis:** Dosing varies widely by procedure (typically 10–20 mg/kg IV bolus). Refer to institutional protocol.
## Pediatric Dosing
* **Trauma (Off-label):** 15–30 mg/kg IV bolus (max 1 g), followed by 2–5 mg/kg/hour infusion for up to 8 hours. Consult institutional pediatric guidelines.
* **Hereditary Angioedema:** 10 mg/kg orally two to three times daily (max 1.5 g/dose).
## Dose Adjustments
* **Renal Impairment:** Requires dose reduction in moderate-to-severe impairment (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 or avoid.
* **Hepatic Impairment:** No formal dose adjustment required; limited data available.
## Contraindications
* Active intravascular clotting (thromboembolic disease).
* History of deep vein thrombosis (DVT) or pulmonary embolism (PE).
* Acquired defective color vision (prevents monitoring for retinal toxicity).
* Subarachnoid hemorrhage (potential for cerebral vasospasm/ischemia).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Thromboembolic events (PE, DVT, MI, stroke), seizures (especially with rapid IV administration or high doses), visual disturbances (retinal artery/vein occlusion), and allergic reactions.
## Key Drug Interactions
* **Estrogens/Combined Oral Contraceptives:** Concomitant use increases the risk of thromboembolic events.
* **Factor IX complex/Prothrombin complex concentrates:** Increased risk of thrombosis; avoid concomitant use.
* **Thrombolytics:** Antifibrinolytic effect is countered by thrombolytic therapy.
## Monitoring
* Monitor hemoglobin/hematocrit and blood pressure during active bleeding.
* Assess for signs of thromboembolism (calf pain, chest pain, dyspnea).
* Assess for visual changes if therapy is long-term.
* Monitor renal function to guide dose adjustments.
## Clinical Pearls
* **Seizure Risk:** Rapid IV injection can trigger seizures. Always administer as a slow infusion or diluted bolus over 10 minutes.
* **Timing:** TXA efficacy is time-dependent in trauma; benefits diminish significantly if administered >3 hours post-injury.
* **Reconstituting/Stability:** Compatible with 0.9% NaCl and D5W. Do not mix with blood products or penicillin-containing solutions.
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*Disclaimer: This information is for educational purposes. Clinical protocols vary by institution. Always verify current prescribing information, dose calculations, and contraindications against hospital guidelines and official drug monographs (e.g., Lexicomp, UpToDate) before administering medication.*
