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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 the breakdown of fibrin clots. ## Primary Indications * **Trauma:** Management of hemorrhage in trauma patients (CRASH-2 protocol). * **Surgery:** Reduction of perioperative blood loss in cardiac, orthopedic, and gynecologic surgery. * **Obstetrics:** Treatment and prophylaxis of postpartum hemorrhage (PPH). * **General:** Cyclic heavy menstrual bleeding, dental extraction in hemophiliacs, and hereditary angioedema. ## Adult Dosing * **Trauma/Acute Hemorrhage:** 1 g IV bolus over 10 minutes, followed by 1 g IV infusion over 8 hours. * **Heavy Menstrual Bleeding:** 1,300 mg PO three times daily for up to 5 days during menstruation. * **Postpartum Hemorrhage:** 1 g IV push (administered at 1 mL/min). A second 1 g dose may be given if bleeding persists after 30 minutes. ## Pediatric Dosing * **Trauma:** 15 mg/kg (max 1 g) IV bolus, followed by 2 mg/kg/hr infusion for 8 hours (dependent on local institutional protocol). * **Hereditary Angioedema:** 20–25 mg/kg PO three times daily. ## Dose Adjustments * **Renal Impairment:** Dosage must be reduced in patients with moderate to severe renal impairment (CrCl < 50 mL/min) due to renally mediated clearance. * CrCl 30–50 mL/min: 10 mg/kg twice daily. * CrCl 10–30 mL/min: 10 mg/kg once daily. * CrCl < 10 mL/min: 5 mg/kg once daily. ## Contraindications * Acquired defective color vision. * Active intravascular clotting (thromboembolic disease). * Subarachnoid hemorrhage (theoretical risk of cerebral edema/seizure). * Hypersensitivity to TXA. ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal pain. * **Serious:** Thromboembolic events (DVT, PE, MI, stroke), seizures (typically dose-related or with rapid injection), and visual disturbances (e.g., retinal artery obstruction). ## Key Drug Interactions * **Factor IX complex/Prothrombin complex concentrates:** Potential for increased risk of thrombosis. * **Estrogens/Hormonal Contraceptives:** Synergistic risk of venous thromboembolism. ## Monitoring * Monitor for signs of thromboembolism (chest pain, shortness of breath, sudden swelling). * Ophthalmologic exams if long-term treatment is necessary. * Renal function (BUN/SCr) to adjust dosing. * Monitor for seizure activity, especially in patients with a history of epilepsy or after high-dose administration. ## Clinical Pearls * **Administration:** Never administer IV bolus too rapidly; rapid injection can cause hypotension. * **Timing:** For trauma, efficacy is highest if administered within the first 3 hours of injury. * **Off-label use:** Frequently used for epistaxis or trauma-related hemorrhages; dosing often varies by institutional guidelines—always verify against local protocol. *** *Disclaimer: This information is for educational purposes only. Always consult current institutional guidelines and the full manufacturer prescribing information before administering any medication.*