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# Tranexamic Acid ## Overview Tranexamic acid (TXA) is a synthetic lysine analog that acts as a potent antifibrinolytic agent. It competitively inhibits the activation of plasminogen to plasmin, thereby preventing the breakdown of fibrin clots and stabilizing hemostasis. ## Primary Indications * **Hemorrhage:** Traumatic hemorrhage (within 3 hours of injury), postpartum hemorrhage, perioperative blood loss reduction, and heavy menstrual bleeding. * **Hereditary Angioedema:** Short-term prophylaxis for dental or surgical procedures. ## Adult Dosing * **Trauma:** 1 g IV loading dose over 10 minutes, followed by 1 g IV infusion over 8 hours. Administer as soon as possible after injury. * **Postpartum Hemorrhage:** 1 g IV over 10 minutes. If bleeding persists after 30 minutes, a second 1 g dose may be administered. * **Heavy Menstrual Bleeding:** 1,300 mg orally three times daily for up to 5 days during menses. * **Surgical Prophylaxis:** Varies widely by specialty (e.g., orthopedic, cardiac). Common ranges are 10–20 mg/kg IV bolus. ## Pediatric Dosing * **Trauma:** 15 mg/kg IV bolus (max 1 g), followed by 2 mg/kg/hour infusion for 8 hours (or until bleeding stops). * **Hereditary Angioedema:** 10–25 mg/kg orally two to three times daily. * *Note: Off-label use in pediatric trauma is common; protocol should be verified with local institutional guidelines.* ## Dose Adjustments * **Renal Impairment:** Reduce dose in patients with CrCl <50 mL/min. * CrCl 30–50 mL/min: 1 g IV loading, followed by 500 mg IV over 8 hours. * CrCl <30 mL/min: 1 g IV loading, followed by 250 mg IV over 8 hours. * **Hepatic Impairment:** No specific adjustment required. ## Contraindications * Hypersensitivity to TXA. * Active intravascular clotting (thromboembolic disease). * History of venous or arterial thrombosis. * Subarachnoid hemorrhage (due to potential for cerebral vasospasm). * Color vision defects (avoid in patients unable to perform/report vision changes). ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal pain (especially with oral formulations). * **Serious:** Thromboembolic events (DVT, PE, MI, stroke), seizures (particularly with high doses or rapid IV administration), and impairment of color vision. ## Key Drug Interactions * **Estrogens/Hormonal Contraceptives:** Increased risk of thrombosis when used with estradiols. * **Thrombolytic agents:** Antagonistic effect; do not administer concurrently. * **Prothrombin Complex Concentrates (PCCs) / Factor IX:** Avoid concomitant use; increased risk of thrombosis. ## Monitoring * **Clinical:** Monitor for signs of venous or arterial thrombosis (e.g., calf pain/swelling, shortness of breath, chest pain). * **Ophthalmologic:** Baseline and periodic visual exams if long-term therapy is required. * **Renal:** Monitor serum creatinine in patients with baseline impairment. ## Clinical Pearls * **Infusion Speed:** Rapid IV push can cause hypotension; always infuse over at least 10 minutes. * **Seizure Risk:** High doses (particularly in neurosurgery or patients with renal failure) have been associated with tonic-clonic seizures. * **Mechanism:** TXA does not act on platelets; its utility is specifically in the stabilization of existing fibrin clots. * **Protocol Dependency:** Dosing for elective surgery varies significantly by institution; always consult local anesthesia or surgical protocols. *** **Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines vary by institution and patient context. Always verify dosages, contraindications, and administration protocols against your institution's current prescribing information, pharmacy manuals, or verified clinical databases (e.g., Lexicomp, UpToDate) before prescribing or administering medication.