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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 or prevention of excessive bleeding (surgical, trauma, obstetric, or menstrual).
* Hereditary angioedema (prophylaxis).
* Short-term management of hemophilia-related bleeding.
## Adult Dosing
* **Trauma (CRASH-2 protocol):** 1 g IV loading dose over 10 minutes, followed by 1 g IV infusion over 8 hours. Ideally administered within 3 hours of injury.
* **Postpartum Hemorrhage:** 1 g IV over 10 minutes. A second 1 g dose may be administered if bleeding continues or recurs after 30 minutes.
* **Surgery:** Varies widely by protocol; common ranges are 10–30 mg/kg IV.
* **Heavy Menstrual Bleeding:** 1,300 mg (two 650 mg tablets) orally three times daily for a maximum of 5 days during menstruation.
## Pediatric Dosing
* **Trauma (off-label):** 15–30 mg/kg IV (max 1 g) loading dose, followed by 2–10 mg/kg/hour infusion based on institutional trauma protocol.
* **Hemophilia/Surgery:** 25 mg/kg orally or 10 mg/kg IV three to four times daily.
* *Note: Pediatric dosing remains highly variable and should be strictly guided by institution-specific pediatric protocols.*
## Dose Adjustments
* **Renal Impairment:** Requires reduction in dose and/or frequency due to primary renal excretion.
* Serum creatinine 1.4–2.8 mg/dL: 10 mg/kg twice daily.
* Serum creatinine 2.9–5.7 mg/dL: 10 mg/kg daily.
* Serum creatinine >5.7 mg/dL: 10 mg/kg every 48 hours or 5 mg/kg every 24 hours.
## Contraindications
* Active intravascular clotting or history of venous/arterial thrombosis.
* Acquired defective color vision (prevents monitoring of retinal changes).
* Subarachnoid hemorrhage (risk of cerebral ischemia/seizures).
* Hypersensitivity to TXA.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Thromboembolic events (DVT, PE, MI, stroke), seizures (especially with high doses or rapid IV administration), visual disturbances, allergic reactions.
## Key Drug Interactions
* **Thrombolytics/Factor Concentrates (e.g., Factor IX complex):** Increased risk of thrombosis.
* **Estrogen-containing medications:** May increase risk of clots when used concomitantly.
## Monitoring
* **Clinical:** Monitor for signs of thromboembolism (chest pain, dyspnea, calf swelling).
* **Neurological:** Monitor for seizure activity, particularly in patients with pre-existing seizure disorders or those receiving high doses.
* **Ophthalmological:** Periodic eye exams if treatment is continued long-term.
* **Renal:** Monitor for urine output and creatinine clearance in patients with impaired renal function.
## Clinical Pearls
* **Infusion Speed:** IV bolus must be administered slowly. Rapid administration can trigger hypotension.
* **Seizure Risk:** High doses, especially during cardiac surgery or neuraxial anesthesia, are associated with a significant increase in postoperative seizure risk.
* **Trauma Window:** Efficacy for trauma bleeding decreases significantly if administered beyond 3 hours post-injury; risk of mortality may increase if given late.
***Disclaimer:** This information is for educational purposes and does not replace professional clinical judgment. Always verify dosages and protocols with the most current institutional guidelines and product monographs before prescribing or administering medication.*
