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# Tranexamic Acid (TXA)
## Overview
Tranexamic acid is an antifibrinolytic agent that competitively inhibits the activation of plasminogen to plasmin, thereby preventing the degradation of fibrin clots.
## Primary Indications
* Treatment/prevention of hemorrhage (trauma-related, postpartum, surgical).
* Heavy menstrual bleeding.
* Localized fibrinolysis (e.g., dental extractions in hemophilia).
* Hereditary angioedema (prophylaxis).
## Adult Dosing
* **Trauma (CRASH-2 protocol):** 1 g IV bolus over 10 minutes, followed by a 1 g IV infusion over 8 hours. Administer as soon as possible, ideally within 3 hours of injury.
* **Heavy Menstrual Bleeding:** 1.3 g orally three times daily for a maximum of 5 days during menstruation.
* **Surgical Hemorrhage:** Dosing varies widely by protocol (e.g., 10–15 mg/kg IV bolus). Verify against institution-specific surgical guidelines.
## Pediatric Dosing
* **Trauma:** 10 mg/kg (max 1 g) IV bolus over 10 minutes; may consider infusion of 1–2 mg/kg/hr according to pediatric trauma trauma protocols.
* **Note:** Always verify dosing with institutional pediatric protocols; weight-based dosing is critical.
## Dose Adjustments
* **Renal Impairment:** Requires significant dose reduction (e.g., based on eGFR). Avoid if possible in severe renal failure due to accumulation and increased risk of seizures.
* **Hepatic Impairment:** No specific manufacturer guidelines, but exercise caution.
## Contraindications
* Hypersensitivity to TXA.
* Active thromboembolic disease (DVT, PE, cerebral thrombosis).
* Subarachnoid hemorrhage (controversial; expert consultation required).
* History of seizures (increased risk of drug-induced ictal activity, especially with high doses).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain (primarily with oral use).
* **Serious:** Thromboembolic events (PE, DVT, MI), seizures (especially with rapid IV injection or high doses), visual disturbances (retinal artery/vein obstruction), allergic reactions.
## Key Drug Interactions
* **Procoagulants:** Risk of thrombosis significantly increased when combined with Factor IX complex concentrates or anti-inhibitor coagulant complexes.
* **Estrogens:** Increased risk of thrombosis when combined with hormonal contraceptives.
## Monitoring
* Monitor for signs of thromboembolism (e.g., limb swelling, chest pain, dyspnea).
* Monitor neurological status (seizure precautions) if high doses are used.
* Assess visual changes (color vision, visual field).
* Evaluate signs of ongoing bleeding in trauma settings.
## Clinical Pearls
* **IV Administration:** Rapid IV injection must be avoided as it can cause hypotension and seizures; slowly inject at a rate not exceeding 100 mg/min.
* **Time Sensitivity:** Its efficacy is strictly time-dependent in trauma; benefits decrease significantly if started >3 hours post-injury.
* **Do Not Inject Intrathecally:** May cause severe neurotoxicity and death.
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**Educational Disclaimer:** This information is for educational purposes only. Drug protocols, doses, and indications are subject to change. Always verify current prescribing information, institutional guidelines, and clinical status before administering any medication.
