Tranexamic%25252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520acid

# Tranexamic Acid ## Overview Tranexamic acid (TXA) is a synthetic lysine analog that acts as a potent antifibrinolytic agent. It competitively inhibits the activation of plasminogen to plasmin, thereby preventing the breakdown of fibrin clots. ## Primary Indications * **Hemorrhage:** Treatment or prevention of excessive bleeding in trauma, surgery (orthopedic, cardiac, gynecological), and obstetric hemorrhage (postpartum hemorrhage). * **Hereditary Angioedema:** Prophylaxis of acute attacks. * **Heavy Menstrual Bleeding:** Management 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. * **Surgical Prophylaxis:** 10–15 mg/kg IV administered prior to incision. * **Heavy Menstrual Bleeding:** 1,300 mg PO three times daily for up to 5 days during menstruation. * **Hereditary Angioedema:** 1–1.5 g PO 2–3 times daily. ## Pediatric Dosing * **Trauma/Acute Hemorrhage:** 15 mg/kg (up to 1 g) IV loading dose, followed by 2 mg/kg/hour infusion for at least 8 hours or until bleeding stops. * *Note: Dosing often follows institutional trauma protocols or clinical trial guidelines (e.g., PATCH-Trauma).* ## Dose Adjustments * **Renal Impairment:** Requires significant reduction in dosage or increasing the interval. * Serum creatinine 1.4–2.8 mg/dL: 10 mg/kg IV twice daily. * Serum creatinine 2.9–5.7 mg/dL: 10 mg/kg IV daily. * Serum creatinine >5.7 mg/dL: 10 mg/kg IV every 48 hours or 5 mg/kg IV every 24 hours. ## Contraindications * Active intravascular clotting. * History of thromboembolic disease (deep vein thrombosis, pulmonary embolism, cerebral thrombosis). * Acquired defective color vision (prevents monitoring for visual adverse effects). * Subarachnoid hemorrhage (risk of cerebral ischemia). ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal pain. * **Serious:** Thromboembolic events (PE, DVT, MI, stroke), seizures (especially with high-dose or rapid IV administration), visual color disturbances, and retinal artery occlusion. ## Key Drug Interactions * **Estrogens/Combined Oral Contraceptives:** May increase risk of thrombosis. * **Factor IX complex/Prothrombin complex concentrates:** Increased risk of thrombotic complications; avoid concurrent use. * **Thrombolytics:** Concurrent use negates antifibrinolytic effect. ## Monitoring * Baseline and periodic ophthalmologic exams for long-term use. * Monitor for signs of thromboembolism (DVT, PE). * Renal function (BUN/SCr) for dose adjustments. * Neurological status (risk of convulsions with high doses). ## Clinical Pearls * **Seizure Risk:** Rapid IV injection must be avoided to prevent hypotension and seizures; always adhere to recommended infusion times. * **PO vs. IV:** Oral TXA is generally for chronic conditions (HAE, menses); IV is for acute surgical or trauma-related bleeding. * **Local Protocols:** Always verify trauma dosing against local institutional guidelines, as resuscitation protocols may vary (e.g., fixed-dose vs. weight-based). * **Compatibility:** Compatible with most standard crystalloids (NS, LR, D5W), but avoid mixing with penicillin in the same IV line. *** **Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Prescribing practices and clinical protocols vary by institution and patient-specific factors. Always verify current, full prescribing information and local hospital guidelines before administration.