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# Tranexamic Acid (TXA) ## Overview Tranexamic acid is a synthetic lysine analog that acts as an antifibrinolytic agent. It competitively inhibits the activation of plasminogen to plasmin, thereby preventing the degradation of fibrin clots. ## Primary Indications * **Trauma:** Management of hemorrhage in severely injured patients. * **Surgery:** Reduction of blood loss during cardiac, orthopedic, and trauma-related surgeries. * **Menorrhagia:** Treatment of heavy menstrual bleeding. * **Dental:** Hemorrhage prevention in patients with hemophilia (adjunctive). * **Epistaxis:** Management of severe or refractory bleeding. ## Adult Dosing * **Trauma:** 1 g IV loading dose over 10 minutes, followed by 1 g IV infusion over 8 hours. * **Heavy Menstrual Bleeding:** 1,300 mg PO three times daily for up to 5 days during menstruation. * **Cardiac/Major Surgery:** Variable based on protocol (e.g., 10–20 mg/kg loading dose, followed by 1–10 mg/kg/hr infusion). Consult institutional surgical guidelines. ## Pediatric Dosing * **Trauma:** 15 mg/kg IV loading dose (max 1 g), followed by 2 mg/kg/hr infusion for 8 hours (dependent on institution-specific trauma protocols). * **Hereditary Angioedema:** 25 mg/kg PO twice daily (max 1.5 g/dose). ## Dose Adjustments * **Renal Impairment:** Reduce dose in patients with impaired renal function (CrCl < 50 mL/min) due to risk of accumulation. * CrCl 30–50 mL/min: 10 mg/kg IV once daily (or reduced infusion rate). * CrCl < 10 mL/min: 5 mg/kg IV once daily. ## Contraindications * Active intravascular clotting. * History of venous or arterial thrombosis. * Subarachnoid hemorrhage (controversial; risk of cerebral ischemia). * Color vision deficiency or acquired defective color vision (risk of retinal changes). ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal cramps. * **Serious:** Thromboembolic events (DVT, PE, MI, stroke), seizures (especially with high doses or rapid administration), visual disturbances. ## Key Drug Interactions * **Estrogens/Oral Contraceptives:** Concomitant use increases the risk of thrombosis. * **Procoagulants (e.g., Factor IX complex, Anti-inhibitor Coagulant Complex):** Theoretically increases risk of thrombosis; avoid overlapping administration. ## Monitoring * Monitor for signs of venous or arterial thromboembolism (unilateral limb swelling, chest pain, dyspnea). * Neurological status (seizure monitoring, especially in cardiac surgery patients). * Visual/Ophthalmological exams during long-term therapy. * Renal function (BUN/SCr). ## Clinical Pearls * **Seizure Risk:** High-dose TXA, particularly in cardiac surgery or following intrathecal administration (which is contraindicated), is associated with a significant risk of tonic-clonic seizures. * **Administration:** When using IV for trauma, the loading dose should be infused over 10 minutes to avoid rapid-infusion hypotension. * **Oral Formulations:** Must be swallowed whole; avoid crushing. *** **Educational Disclaimer:** This information is for educational purposes only and does not supersede institutional protocols. Dosage and clinical practices may vary significantly by facility, indication, and patient-specific factors. Always consult the latest package insert, official clinical guidelines (e.g., ATLS, American College of Obstetricians and Gynecologists), and hospital pharmacy department to verify current prescribing information before administration.