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 the breakdown of fibrin clots.
## Primary Indications
* **Trauma-related hemorrhage:** Management of severe bleeding (CRASH-2 protocol).
* **Postpartum hemorrhage (PPH):** Prevention and treatment.
* **Surgical prophylaxis:** Reduction of blood loss in cardiovascular, orthopedic, and spinal surgeries.
* **Menorrhagia:** Treatment of heavy menstrual bleeding.
* **Epistaxis/Dental bleeding:** Adjunctive local therapy.
## Adult Dosing
* **Trauma:** 1 g IV loading dose over 10 minutes, followed by 1 g IV infusion over 8 hours. Administer within 3 hours of injury.
* **Postpartum Hemorrhage:** 1 g IV over 10 minutes. If bleeding persists after 30 minutes, a second 1 g dose may be administered.
* **Surgery:** Varies widely by protocol; typically 10–15 mg/kg pre-operatively or 1 g bolus followed by variable infusion.
* **Heavy Menstrual Bleeding:** 1.3 g orally three times daily for a maximum of 5 days during menses.
## Pediatric Dosing
* **Trauma:** 15–20 mg/kg IV loading dose (max 1 g), followed by 2 mg/kg/hour infusion (if indicated by protocol).
* **Note:** Pediatric dosing is highly protocol-dependent. Consult institution-specific guidelines for off-label use.
## Dose Adjustments
* **Renal Impairment:** Requires dose reduction in patients with moderate-to-severe impairment (CrCl <50 mL/min) due to renal excretion.
* **Dialysis:** Requires post-dialysis dosing; use with extreme caution.
## Contraindications
* **Active intravascular clotting:** History of deep vein thrombosis (DVT), pulmonary embolism (PE), or cerebral thrombosis.
* **Acquired disturbances of color vision:** Defective color vision may prevent assessment of retinal toxicity.
* **Subarachnoid hemorrhage:** Risk of cerebral vasospasm.
* **Hypersensitivity:** Known allergy to tranexamic acid.
## Adverse Effects
* **Gastrointestinal:** Nausea, vomiting, diarrhea (usually with oral dosing).
* **Thromboembolic:** Increased risk of DVT, PE, or stroke.
* **Neurological:** Seizures (notably with high doses or rapid IV administration).
* **Ocular:** Visual disturbances (blurred vision, color changes).
* **Hypotension:** Rapid IV infusion can cause transient drops in blood pressure.
## Key Drug Interactions
* **Prothrombin Complex Concentrates (PCCs)/Factor IX:** Increased risk of thromboembolism when combined with antifibrinolytics.
* **Estrogens:** Oral contraceptives increase the risk of thrombosis when used with TXA.
## Monitoring
* **Neurological status:** Monitor for signs of seizure activity, especially in patients with a history of epilepsy or high dosing.
* **Renal function:** Monitor renal output and serum creatinine in patients with baseline impairment.
* **Thrombotic signs:** Monitor for signs of PE (dyspnea, chest pain) or DVT (unilateral leg pain/swelling).
## Clinical Pearls
* **Speed Matters:** In trauma, the benefit decreases significantly if delayed beyond 3 hours post-injury; "time is blood."
* **Seizure Risk:** Avoid rapid bolus injection in neuraxial anesthesia settings, as high neuraxial levels are associated with profound seizure risk.
* **Oral vs. IV:** Oral formulations are not interchangeable with IV formulations for acute hemorrhage management.
* **Local Protocol:** Always verify the specific trauma or surgical protocol at your facility, as dosing regimens vary significantly across global standards.
***
**Educational Disclaimer:** This information is for educational purposes only. Drug dosing, indications, and contraindications may change. Always verify current prescribing information through official resources (e.g., package inserts, Lexicomp, UpToDate) and adhere to your local institutional protocols before prescribing or administering medication.
