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# Tranexamic Acid
## Overview
Tranexamic acid (TXA) is an 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 patients with (or at risk of) significant bleeding.
* **Surgery:** Prevention/reduction of perioperative blood loss (e.g., cardiac, orthopedic, trauma).
* **Obstetrics:** Management of postpartum hemorrhage (PPH) or heavy menstrual bleeding.
* **Dentistry:** Prevention of hemorrhage in patients with coagulopathies (e.g., hemophilia).
## Adult Dosing
* **Trauma:** 1g IV bolus over 10 minutes, followed by 1g IV infusion over 8 hours.
* **Postpartum Hemorrhage:** 1g IV bolus at 1 mL/min. If bleeding continues after 30 minutes, a second 1g dose may be administered.
* **Heavy Menstrual Bleeding:** 1300 mg PO three times daily for up to 5 days during menses.
* **Surgical Prophylaxis:** Dosing varies widely by procedure (typically 10–30 mg/kg IV). Consult institutional protocol.
## Pediatric Dosing
* **Trauma:** 15 mg/kg (max 1g) IV bolus, followed by 2 mg/kg/hour infusion for 8 hours (limited data on efficacy/safety compared to adults).
* **Hereditary Angioedema:** 25 mg/kg PO twice daily (max 1.5g/dose).
* *Note: Pediatric dosing is often off-label; consult institutional protocols.*
## Dose Adjustments
* **Renal Impairment:** Requires reduction in dose and frequency based on serum creatinine/CrCl (TXA is renally cleared).
* **Hepatic Impairment:** No standard dosage adjustment established.
## Contraindications
* History of venous or arterial thrombosis.
* Current thromboembolic disease (DVT, pulmonary embolism).
* Active intravascular clotting.
* Subarachnoid hemorrhage (due to risk of cerebral ischemia).
* Hypersensitivity to TXA.
* Acquired defective color vision.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Thromboembolic events (PE, DVT, MI, stroke), seizures (if administered rapidly or at high doses), hypotension (with rapid IV injection), and visual disturbances.
## Key Drug Interactions
* **Thrombolytics:** Concurrent use may negate the effects of thrombolytic therapy.
* **Estrogens/Hormonal Contraceptives:** May increase the risk of thrombosis when used in combination with antifibrinolytics.
* **Factor IX complex/Antinhibitor Coagulant Concentrates:** Theoretically increases risk of thrombosis.
## Monitoring
* Monitor for signs/symptoms of thromboembolism (chest pain, dyspnea, calf swelling).
* Monitor neurological status (seizure precautions, especially in patients with renal impairment).
* Renal function (BUN/SCr) in patients receiving prolonged or repeated therapy.
* Visual/Ophthalmological exams during long-term therapy.
## Clinical Pearls
* **Rapid Administration:** IV bolus must be administered slowly. Rapid administration can cause hypotension, dizziness, and tachycardia.
* **Seizure Risk:** High doses, particularly in neurosurgical procedures or patients with renal impairment, are associated with an increased risk of seizures.
* **Trauma "Golden Hour":** TXA efficacy is significantly time-dependent; it is most effective when administered within the first 3 hours of injury.
* **Compatibility:** Compatible with saline and dextrose solutions; sensitive to specific medication additives (e.g., penicillins or blood products).
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**Educational Disclaimer:** This information is intended for educational purposes only and does not constitute medical advice. Dosing and clinical protocols vary by institution and patient-specific factors. Always consult the most current prescribing information (package insert) and hospital-approved clinical guidelines before administering medication.
