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# Tranexamic Acid (TXA) ## Overview Tranexamic acid 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 * **Hemorrhage control:** Trauma, postpartum hemorrhage, and surgical bleeding. * **Menorrhagia:** Treatment of cyclic heavy menstrual bleeding. * **Hereditary Angioedema (HAE):** Prophylaxis. * **Dental extraction:** Short-term use in patients with coagulopathies (e.g., hemophilia). ## Adult Dosing * **Trauma/Acute Hemorrhage:** 1 g IV loading dose over 10 minutes, followed by 1 g IV infusion over 8 hours (CRASH-2 protocol). * **Menorrhagia:** 1.3 g orally three times daily for up to 5 days during menstruation. * **Dental Extraction (Hemophilia):** 10 mg/kg IV immediately before surgery, followed by 25 mg/kg orally 3–4 times daily for 2–8 days. ## Pediatric Dosing * **Trauma:** 15 mg/kg IV loading dose (max 1 g), followed by 2 mg/kg/hour infusion (max 1 g/hour) for up to 8 hours. Note: Dosing for pediatric trauma often varies by local hospital protocol (e.g., MART-1 protocol). * **Dental Extraction:** 25 mg/kg orally or 10 mg/kg IV 3–4 times daily. ## Dose Adjustments * **Renal Impairment:** Requires reduction in dose and/or frequency due to renal excretion. * Creatinine 1.36–2.8 mg/dL: Use 10 mg/kg BID. * Creatinine 2.8–5.7 mg/dL: Use 10 mg/kg daily. * Creatinine >5.7 mg/dL: Use 10 mg/kg every 48 hours or 5 mg/kg every 24 hours. ## Contraindications * Active intravascular clotting (thromboembolic disease). * History of venous or arterial thrombosis. * Acquired defective color vision (prevents monitoring for visual side effects). * Subarachnoid hemorrhage (risk of cerebral ischemia/seizure). ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal pain. * **Serious:** Thromboembolism (DVT, PE, MI, stroke), seizures (especially with rapid IV push or high doses), visual disturbances (retinal artery obstruction). ## Key Drug Interactions * **Thrombolytics/Fibrinolytics:** Antagonistic effect; avoid concurrent use. * **Estrogens/Combined Hormonal Contraceptives:** Increased risk of thrombosis. * **Prothrombin Complex Concentrates (PCCs/FEIBA):** Theoretical risk of increased thrombogenicity; monitor closely. ## Monitoring * **Clinical:** Signs of thromboembolism (calf pain, chest pain, dyspnea). * **Neurological:** Monitor for seizures, particularly in patients with renal failure. * **Ophthalmological:** Baseline and periodic eye exams if long-term treatment is necessary. ## Clinical Pearls * **IV Administration:** Rapid IV injection can cause hypotension; always infuse over 10 minutes or longer. * **Seizure Risk:** TXA is structurally similar to GABA-A receptor antagonists. Seizures have been reported, especially with inadvertent neuraxial administration; **never administer intrathecally.** * **Trauma Window:** TXA is most effective when administered within 3 hours of injury. Benefit decreases significantly after 3 hours. *** *Disclaimer: This information is for educational purposes only. Always verify current prescribing information, institutional protocols, and specific patient contraindications via reliable clinical resources (e.g., Lexicomp, UpToDate, or local formulary) before prescribing or administering medication.*