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# Tranexamic Acid ## Overview Tranexamic acid (TXA) is a synthetic antifibrinolytic agent that competitively inhibits 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 blood loss during cardiac, orthopedic, and gynecologic procedures. * **Obstetrics:** Treatment of postpartum hemorrhage (WOMAN trial). * **Other:** Hemostatic adjunct in dental procedures (hemophiliacs), menorrhagia, and epistaxis. ## Adult Dosing * **Trauma (Hemorrhage):** 1 g IV loading dose over 10 minutes, followed by 1 g IV infusion over 8 hours. * **Menorrhagia:** 1.3 g orally three times daily for up to 5 days during menses. * **Dental (Hemophiliacs):** 25 mg/kg IV immediately before surgery, followed by 25 mg/kg orally every 6–8 hours for 2–8 days. * **Note:** Dosing varies significantly by institutional protocol and surgical specialty. ## Pediatric Dosing * **Trauma/Surgery:** 10–20 mg/kg IV loading dose, followed by 1–10 mg/kg/hour infusion. * **Note:** There is no universally standardized pediatric dose; institutional protocols must be strictly followed. Use with caution in neonates. ## Dose Adjustments * **Renal Impairment:** Requires significant reduction in dosage or frequency due to renal clearance of the drug. * Creatinine clearance 30–50 mL/min: 10 mg/kg IV daily or 5 mg/kg every 12 hours. * Creatinine clearance 10–30 mL/min: 10 mg/kg IV every 48 hours or 5 mg/kg every 24 hours. * Creatinine clearance <10 mL/min: 5 mg/kg IV every 48 hours or 2.5 mg/kg every 24 hours. * **Hepatic Impairment:** No specific dosage adjustments established. ## Contraindications * Active intravascular clotting (thromboembolic disease). * History of deep vein thrombosis (DVT) or pulmonary embolism (PE). * Subarachnoid hemorrhage (theoretical risk of cerebral vasospasm). * Acquired color vision disturbances (use caution if necessary). ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal pain. * **Serious:** Thromboembolic events (DVT, PE, MI, stroke), seizures (especially with rapid IV administration or high doses), retinal arterial/venous occlusion. ## Key Drug Interactions * **Factor IX complex/Prothrombin complex concentrates:** Increased risk of thrombosis. * **Estrogens:** Increased risk of thrombosis when used with contraceptives or hormone replacement. * **Thrombolytics:** Antagonizes the effect; avoid concurrent use. ## Monitoring * **Assess:** Hemodynamic status, hemoglobin/hematocrit, and urine output. * **Observation:** Monitor for clinical signs of thrombosis (swelling, chest pain, dyspnea) and localized visual impairment. ## Clinical Pearls * **Seizure Risk:** Rapid IV injection can trigger seizures. Administer slowly (typically <100 mg/min). * **Timing:** Efficacy is highly time-dependent in trauma; benefits decrease significantly if administered more than 3 hours post-injury. * **Oral vs IV:** Oral formulations are primarily indicated for menorrhagia; IV is the standard for acute hemorrhage. * **Stability:** Once diluted, IV solutions should generally be used within 24 hours. *** *Disclaimer: This information is for educational purposes only. Clinical protocols and dosage recommendations may vary based on local standards, patient-specific comorbidities, and updated literature. Always verify current prescribing information, institutional guidelines, and drug monographs before clinical administration.*