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# Tranexamic Acid ## Overview Tranexamic acid (TXA) is a synthetic antifibrinolytic agent that competitively inhibits the activation of plasminogen to plasmin, thereby preventing the degradation of fibrin clots. ## Primary Indications * **Hemorrhage Control:** Severe trauma (e.g., CRASH-2 protocol), surgical blood loss reduction, and postpartum hemorrhage. * **Hematology:** Short-term use in patients with hemophilia undergoing dental procedures. * **Menstruation:** Treatment of cyclic heavy menstrual bleeding. ## Adult Dosing * **Trauma/Acute Hemorrhage:** 1 g IV loading dose over 10 minutes, followed by 1 g IV infusion over 8 hours. Administer as soon as possible, ideally within 3 hours of injury. * **Heavy Menstrual Bleeding (Oral):** 1.3 g orally three times daily for up to 5 days during menses. * **Dental Procedure (Hemophiliacs):** 10 mg/kg IV immediately before surgery, followed by 25 mg/kg orally three times daily for 2–8 days. ## Pediatric Dosing * **Trauma:** 15–20 mg/kg IV loading dose (max 1 g), followed by 2 mg/kg/hour infusion for 8 hours (or titrated per local pediatric trauma protocol). * **Off-label/Specialized:** Dosing varies widely by indication; consultation with hematology/pediatric pharmacy is strongly recommended. ## Dose Adjustments * **Renal Impairment:** Reduce dose in patients with a creatinine clearance <50 mL/min. * CrCl 30–50 mL/min: 10 mg/kg IV twice daily. * CrCl 10–30 mL/min: 10 mg/kg IV daily. * CrCl <10 mL/min or dialysis: 5 mg/kg IV daily. ## Contraindications * History of venous or arterial thrombosis. * Active intravascular clotting. * Subarachnoid hemorrhage (theoretical risk of seizure). * Acquired defective color vision (prevents monitoring). * Hypersensitivity to tranexamic acid. ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, and abdominal pain. * **Serious:** Thromboembolic events (DVT, PE, MI, stroke), seizures (especially with rapid IV injection or high doses), and visual disturbances (e.g., retinal artery occlusion). ## Key Drug Interactions * **Thrombolytics:** Concurrent use may antagonize effects; avoid combination. * **Estrogens/Hormonal Contraceptives:** Potential increased risk of thrombosis due to pro-coagulant effects. * **Factor IX Complex/Anti-inhibitor Coagulant Concentrates:** Increased risk of thrombosis. ## Monitoring * Monitor hemoglobin/hematocrit and blood pressure during active bleeding. * Assess for clinical signs of thrombosis (leg pain, chest pain, vision changes). * Neurological status (seizure monitoring, particularly in trauma patients or those receiving bolus doses). ## Clinical Pearls * **Seizure Risk:** Rapid IV injection must be avoided; always infuse over at least 10 minutes. * **Injection Safety:** **Never administer intrathecally**; accidental spinal injection is often fatal. * **CRASH-2 Protocol:** Benefits diminish significantly after 3 hours post-injury; do not initiate after 3 hours unless directed by trauma guidelines. * **Visual Exams:** Perform baseline and periodic eye exams during long-term therapy. *** **Disclaimer:** This information is for educational purposes only. Dosing may vary based on institutional protocols or specific clinical guidelines. Always cross-reference with the most current product labeling, institutional formulary, or reputable clinical databases (e.g., Lexicomp, Micromedex) before prescribing or administering medication.