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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 fibrin clot dissolution. ## Primary Indications * Treatment/prophylaxis of hemorrhage associated with excessive fibrinolysis. * Heavy menstrual bleeding. * Trauma-related hemorrhage (CRASH-2 protocol). * Cardiac surgery, orthopedic surgery, and dental procedures in patients with coagulopathies. ## Adult Dosing * **Trauma (Hemorrhage):** 1 gram IV bolus over 10 minutes, followed by 1 gram continuous IV infusion over 8 hours. Administer as soon as possible, ideally within 3 hours of injury. * **Heavy Menstrual Bleeding:** 1,300 mg PO three times daily for up to 5 days during menstruation. * **Surgical Prophylaxis:** Dosing varies widely by institution (e.g., 10–20 mg/kg IV bolus). Verify local surgical protocols. ## Pediatric Dosing * **Trauma/Hemorrhage:** 10–20 mg/kg IV bolus (max 1g), followed by 2–10 mg/kg/hr infusion. * *Note: Pediatric dosing is frequently extrapolated from adult data; consult institutional guidelines or specialized pediatric pharmacology references (e.g., Neofax or Lexicomp) for weight-based protocols.* ## Dose Adjustments * **Renal Impairment:** Dosage reduction is required for CrCl <50 mL/min. * CrCl 30–50 mL/min: 1 g IV daily or 0.5 g IV twice daily. * CrCl 10–29 mL/min: 0.5 g IV daily or 0.25 g IV twice daily. * CrCl <10 mL/min: 0.5 g IV every 48 hours or 0.25 g IV every 24 hours. ## Contraindications * Active intravascular clotting. * History of venous or arterial thrombosis (unless the benefit clearly outweighs the risk). * Subarachnoid hemorrhage (due to risk of cerebral ischemia/seizure). * Color vision disturbances (defective color vision). ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal pain, headache. * **Serious:** Thromboembolic events (DVT, PE, MI, stroke), seizures (particularly with rapid IV injection or high doses), allergic reactions, hypotension (with rapid IV infusion). ## Key Drug Interactions * **Thrombolytics:** Concurrent use may defeat the purpose of thrombolytic therapy; generally contraindicated. * **Estrogens/Hormonal Contraceptives:** May increase the risk of thrombosis when used with TXA. * **Prothrombin Complex Concentrates (PCCs) or Factor IX:** Increased risk of thrombosis. ## Monitoring * Monitor for signs/symptoms of thromboembolism (e.g., leg pain/swelling, chest pain, dyspnea). * Monitor neurological status in patients at risk for seizures. * Assess vision if therapy is prolonged. * Renal function (baseline and during therapy if dose adjustments are necessary). ## Clinical Pearls * **Avoid IM injection:** Tissue necrosis can occur. * **Rate of administration:** IV bolus should be slow (typically >10 minutes) to avoid hypotension. * **Seizure Risk:** High doses, particularly in cardiac surgery or following intrathecal administration (which is contraindicated), are associated with a significant risk of seizures. * **Trauma Window:** Efficacy drastically decreases if administered more than 3 hours post-injury. *** **Educational Disclaimer:** This information is intended for educational purposes for healthcare professionals. Dosage, indications, and contraindications may vary by hospital protocol and regulatory approval. Always verify current prescribing information, institutional guidelines, and the manufacturer's official FDA label before administering medication.