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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. ## Primary Indications * **Trauma-associated hemorrhage:** Reduction of mortality in patients with significant hemorrhage. * **Surgical Hemorrhage:** Reduction of blood loss in orthopedic, cardiac, and dental procedures (e.g., in patients with hemophilia). * **Heavy Menstrual Bleeding:** Management of cyclic heavy menstrual bleeding. * **Hereditary Angioedema:** Short-term prophylaxis (off-label). ## Adult Dosing * **Trauma:** 1 g IV bolus over 10 minutes, followed by 1 g IV infusion over 8 hours. Administer as soon as possible, ideally within 3 hours of injury. * **Heavy Menstrual Bleeding:** 1,300 mg orally three times daily for a maximum of 5 days during each menstrual cycle. * **Surgical Prophylaxis:** Varies significantly by procedure; common range is 10–20 mg/kg IV bolus pre-procedure followed by infusion or additional doses. *Verify against local clinical protocols.* ## Pediatric Dosing * **Trauma (Off-label):** 15 mg/kg (max 1 g) IV bolus, followed by 2 mg/kg/hour infusion for up to 8 hours. * **Hereditary Angioedema:** 10 mg/kg orally up to 3 times daily. * *Note: Pediatric dosing often relies on institutional protocols; verify all weight-based calculations.* ## Dose Adjustments * **Renal Impairment:** Requires dosage reduction for oral dosing in patients with CrCl <50 mL/min. In severe renal impairment (CrCl <30 mL/min), use is generally avoided or significantly extended. * **Hepatic Impairment:** No specific adjustment necessary, but use with caution. ## Contraindications * Acquired defective color vision (prevents monitoring of retinal toxicities). * Active intravascular clotting (e.g., DVT, pulmonary embolism, cerebral thrombosis). * Subarachnoid hemorrhage (due to risk of cerebral ischemia/edema). * Hypersensitivity to tranexamic acid. ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal pain, headache, back pain, musculoskeletal pain. * **Serious:** Thromboembolic events (DVT, PE, MI, stroke), seizures (particularly with rapid IV injection or high doses in neurosurgery), visual changes, and allergic skin reactions. ## Key Drug Interactions * **Factor IX complex/Prothrombin complex concentrates:** Increased risk of thrombotic complications; avoid concurrent use. * **Hormonal Contraceptives:** Concomitant use with estrogen-containing products may increase the risk of thrombosis. * **Thrombolytics:** Direct pharmacologic antagonism; concomitant use is contraindicated. ## Monitoring * **Thromboembolism:** Monitor for signs of DVT/PE (e.g., calf pain, shortness of breath, chest pain). * **Neurologic:** Monitor for signs of seizure activity, especially if high doses are used. * **Ophthalmologic:** Regular eye examinations recommended for patients on long-term therapy. * **Renal:** Monitor CrCl in patients with pre-existing renal disease. ## Clinical Pearls * **"Time is Tissue":** In trauma settings, the survival benefit of TXA diminishes rapidly after 3 hours post-injury. * **Administration Safety:** Never administer intravenously as a rapid IV push; rapid delivery can cause hypotension. Always infuse over at least 10 minutes. * **Intrathecal/Epidural:** **Never** administer TXA via the intrathecal or epidural route; this can lead to severe neurotoxicity and is often fatal. * **Oral formulations:** Do not crush or chew extended-release tablets. *** *Disclaimer: This information is for educational purposes only. Clinical practice guidelines and local institutional protocols, particularly regarding weight-based pediatric dosing and surgical prophylaxis, must be verified with current prescribing information and your facility’s pharmacology resources before administration.*