Please check your internet connection and try again.
# Tranexamic Acid
## Overview
Tranexamic acid (TXA) is a synthetic lysine analog that acts as an antifibrinolytic agent by reversibly blocking lysine-binding sites on plasminogen, thereby inhibiting the conversion of plasminogen to plasmin and preventing the degradation of fibrin clots.
## Primary Indications
* Treatment/prevention of hemorrhage (trauma, surgical, obstetric).
* Heavy menstrual bleeding.
* Hereditary angioedema (prophylaxis).
* Dental surgery in patients with coagulopathies.
## Adult Dosing
* **Trauma (CRASH-2 protocol):** 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 up to 5 days during menstruation.
* **Surgical Hemorrhage:** Varies by procedure and facility protocol; common range 10–30 mg/kg IV.
## Pediatric Dosing
* **Trauma:** 15 mg/kg (max 1 g) IV bolus, followed by 2 mg/kg/hour infusion for 8 hours (based on the Paediatric Emergency Research Networks/PED-TRAUMA guidance).
* **Off-label surgical/mucosal bleeding:** 10–25 mg/kg IV or 25 mg/kg orally every 8 hours.
## Dose Adjustments
* **Renal Impairment:** Requires dose reduction in patients with CrCl < 50 mL/min.
* CrCl 30–50 mL/min: Reduce dose by 50%.
* CrCl 10–30 mL/min: Reduce dose by 75%.
* CrCl < 10 mL/min: Reduce dose by 87.5%.
* **Hepatic Impairment:** No standard dosage adjustment required, but use with caution.
## Contraindications
* Acquired defective color vision.
* Active intravascular clotting (e.g., history of DVT, PE, or occlusive arterial disease).
* Subarachnoid hemorrhage (controversial; risk of cerebral ischemia).
* Hypersensitivity to TXA.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, headache.
* **Serious:** Thromboembolic events (DVT, PE, MI, stroke), seizures (particularly with rapid IV administration or doses exceeding recommendations), visual disturbances/retinal artery occlusion.
## Key Drug Interactions
* **Thrombolytics:** Concomitant use may antagonize effects; avoid combining (e.g., alteplase).
* **Estrogens/Oral Contraceptives:** Increased risk of thrombosis.
* **Factor IX complex/Antinhibitor coagulant concentrates:** Potential increased risk of thrombotic complications.
## Monitoring
* Monitor for signs of venous/arterial thrombosis (calf pain, chest pain, dyspnea).
* Evaluate neurological status (seizure risk is higher in neurosurgical or high-dose scenarios).
* Ophthalmologic exams if long-term treatment is necessary.
* Renal function (CrCl).
## Clinical Pearls
* **IV Administration:** Administer slowly. Rapid IV injection may cause transient hypotension.
* **Seizure Risk:** Do not exceed 100 mg/min IV; high plasma concentrations, potentially resulting from dose-over-weight calculation errors in renal failure, increase seizure risk.
* **Local Policy:** Always check institutional protocols, especially for trauma and massive transfusion guidelines, as dosing may differ significantly from manufacturer labeling.
***
**Educational Disclaimer:** This information is for educational purposes for healthcare professionals and does not constitute medical advice. Always verify current, institution-specific prescribing information, dosage guidelines, and contraindications in clinical drug databases (e.g., Lexicomp, Micromedex) or the official product monograph before administration.
