Please check your internet connection and try again.
# 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
* Treatment/prevention of hemorrhage due to hyperfibrinolysis (trauma, surgery).
* Heavy menstrual bleeding.
* Hereditary angioedema (prophylaxis).
* Dental surgery in patients with bleeding disorders (e.g., hemophilia).
## Adult Dosing
* **Trauma (CRASH-2 protocol):** 1 g IV loading dose over 10 minutes, followed by 1 g IV infusion over 8 hours.
* **Heavy Menstrual Bleeding:** 1.3 g orally three times daily for up to 5 days during menstruation.
* **Dental/Surgical Procedures:** 10–15 mg/kg IV prior to procedure; may be followed by oral doses post-operatively (usually 25 mg/kg TID for 2–8 days) depending on local protocol.
## Pediatric Dosing
* **Trauma (Pediatric Trauma Guidelines):** 15 mg/kg IV loading dose (max 1 g), followed by 2 mg/kg/hour infusion for 8 hours (max 1 g total infusion). *Note: Off-label use; always consult institutional pediatric guidelines.*
* **Hereditary Angioedema:** 10 mg/kg orally three times daily (max 1.5 g/dose).
## Dose Adjustments
* **Renal Impairment:** Requires dosage reduction based on serum creatinine/GFR. For severe impairment (CrCl <30 mL/min), doses should be reduced, and interval extended. Hemodialysis patients require careful titration post-dialysis.
## Contraindications
* Hypersensitivity to TXA.
* Active intravascular clotting (thrombosis/embolism).
* Subarachnoid hemorrhage (theoretical risk of cerebral infarction).
* Acquired defective color vision (prevents monitoring of retinal toxicity).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Thromboembolic events (DVT, PE, stroke, MI), seizures (especially with rapid IV administration or high doses), visual disturbances (retinal artery/vein obstruction), and allergic reactions.
## Key Drug Interactions
* **Thrombolytics:** Concurrent use significantly opposes the therapeutic effect of thrombolytic agents.
* **Estrogens/Hormonal Contraceptives:** Increased risk of thrombosis when used combination with TXA.
* **Prothrombin Complex Concentrates (PCCs)/Factor IX:** Potential increased risk of thrombosis.
## Monitoring
* Monitor for signs/symptoms of thromboembolism.
* Ophthalmologic exams for long-term therapy.
* Renal function (BUN/Cr) periodically.
* Neurological status (seizure risk).
## Clinical Pearls
* **Seizure Risk:** Rapid IV injection can trigger seizures, particularly in patients with a history of epilepsy or those undergoing cardiac surgery. Always infuse over at least 10–30 minutes.
* **Administration:** Oral tablets should not be crushed. IV forms may be administered topically in some surgical settings (consult hospital policy).
* **Uncertainty:** Dosing in massive hemorrhage is highly protocol-dependent; clinicians should strictly adhere to institutional massive transfusion protocols.
***
**Educational Disclaimer:** This information is for educational purposes only. Drug dosing, contraindications, and guidelines change frequently. Always consult the most current official prescribing information (package insert) and your institution’s antimicrobial stewardship or pharmacy and therapeutics committee protocols before prescribing or administering medication.
