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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 * **Hemorrhage Control:** Trauma-related (CRASH-2/MATTERS protocols), postpartum hemorrhage, perioperative blood loss (cardiac, orthopedic, spinal surgery). * **Mucosal Bleeding:** Menorrhagia, epistaxis, or dental extraction in patients with coagulopathies. * **Hereditary Angioedema:** Short-term prophylaxis (off-label). ## Adult Dosing * **Trauma/Acute Hemorrhage:** 1 g IV bolus over 10 minutes, followed by 1 g IV infusion over 8 hours (or titrated per local hospital protocol). * **Menorrhagia:** 1,300 mg orally every 8 hours for up to 5 days during menstruation. * **Surgery (Pre-op):** 10 mg/kg to 30 mg/kg IV bolus (varies by surgical type). ## Pediatric Dosing * **Trauma:** 15 mg/kg (max 1 g) IV bolus, followed by 2 mg/kg/hour infusion for 8 hours. * **Significant Bleeding:** 10–20 mg/kg PO or IV every 8 hours. * *Note: Pediatric dosing is often institution-specific; confirm with current clinical pathway.* ## Dose Adjustments * **Renal Impairment:** Requires reduction in dose based on creatinine clearance (CrCl). * CrCl 30–50 mL/min: 10 mg/kg IV or 5 mg/kg PO every 12 hours. * CrCl 10–30 mL/min: 10 mg/kg IV or 5 mg/kg PO every 24 hours. * CrCl <10 mL/min or dialysis: 5 mg/kg IV or 2.5 mg/kg PO every 24 hours. * **Hepatic Impairment:** No specific adjustment necessary. ## Contraindications * Active intravascular clotting (thromboembolic disease). * History of deep vein thrombosis (DVT) or pulmonary embolism (PE). * History of subarachnoid hemorrhage (use with caution in specific neurovascular settings). * Acquired color vision disturbances (prevents monitoring of retinal toxicity). ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal pain. * **Serious:** Thromboembolic events (DVT/PE/MI), seizures (primarily with rapid IV infusion or excessive doses), disturbances in color vision, visual field defects. ## Key Drug Interactions * **Estrogens/Oral Contraceptives:** Concomitant use increases the risk of thrombosis. * **Factor IX complex/Prothrombin complex concentrates:** High risk of thrombotic complications; avoid concurrent use. * **Thrombolytics:** Antagonizes the effect of thrombolytic therapy. ## Monitoring * Monitor for signs of venous or arterial thrombosis (e.g., limb swelling, dyspnea, chest pain). * Regular ophthalmologic exams if long-term therapy is required. * Neurologic assessment for seizure potential if large IV doses are administered. ## Clinical Pearls * **Seizure Risk:** Rapid IV injection can induce seizures. Infuse slowly or administer via controlled pump. * **Timing:** Efficacy in trauma is time-dependent. Greatest clinical benefit for survival is achieved if given within 3 hours of injury. * **Route:** TXA is intended for IV use in acute settings. Avoid inadvertent intrathecal injection, as it is neurotoxic and can cause fatal seizures. *** **Educational Disclaimer:** This information is for educational purposes only. Always consult current institutional protocols and the manufacturer’s package insert to verify dosages and indications before prescribing or administering medication.