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# 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 degradation of fibrin clots and stabilizing hemostasis. ## Primary Indications * **Postpartum Hemorrhage:** Adjunct for treatment of obstetrical hemorrhage. * **Trauma:** Early administration in patients with significant hemorrhage (CRASH-2 protocol). * **Elective Surgery:** Reduction of perioperative blood loss (e.g., orthopedic, cardiac). * **Menorrhagia:** Treatment of heavy menstrual bleeding. * **Dental/Minor Surgery:** Management of bleeding in patients with coagulopathies. ## Adult Dosing * **Trauma:** 1 g IV bolus over 10 minutes, followed by 1 g IV infusion over 8 hours. Administer within 3 hours of injury. * **Postpartum Hemorrhage:** 1 g IV bolus over 10 minutes; a second 1 g dose may be given if bleeding persists or recurs after 30 minutes. * **Heavy Menstrual Bleeding:** 1,300 mg orally three times daily for up to 5 days during menstruation. * **Surgical Prophylaxis:** Doses vary widely by procedure; typically 10–20 mg/kg IV preoperatively. ## Pediatric Dosing * **Trauma/Acute Bleeding:** 10–20 mg/kg (max 1 g) IV bolus, followed by 5–10 mg/kg/hr infusion. * **Note:** Pediatric dosing is often institution-specific. Consult local pediatric protocols or hematology guidelines. ## Dose Adjustments * **Renal Impairment:** Reduce dose in patients with CrCl <50 mL/min. * CrCl 30–50 mL/min: 50% of standard dose. * CrCl 10–30 mL/min: 25% of standard dose. * CrCl <10 mL/min: 10% of standard dose (or avoid). ## Contraindications * **Active Thromboembolic Disease:** Current DVT, PE, or history of cerebral thrombosis. * **Intracranial Bleeding:** General caution; evidence is conflicting. * **Color Vision Defects:** Acquired color vision disturbances (potential for ocular toxicity). * **Subarachnoid Hemorrhage:** Risk of cerebral infarction. ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal pain, headache. * **Serious:** Thromboembolism (DVT, PE, MI, stroke), seizures (particularly with high IV doses or off-label intrathecal/epidural use), allergic reactions, hypotension (if IV infusion is too rapid). ## Key Drug Interactions * **Estrogens/Oral Contraceptives:** Concomitant use increases the risk of thrombosis. * **Prothrombin Complex Concentrates/rFVIIa:** Increased risk of thrombosis due to synergistic pro-coagulant effects. ## Monitoring * **Baseline:** Renal function, coagulation profile (if applicable). * **Ongoing:** Signs of symptomatic venous or arterial thrombosis, visual disturbances, and neurological status (to monitor for seizure activity). ## Clinical Pearls * **Rapid IV Injection:** Never exceed 1 mL/min (100 mg/min) to avoid hypotension. * **Seizure Risk:** Avoid use in patients with a history of epilepsy; use extreme caution in neurosurgical procedures or high-dose scenarios. * **Efficacy:** TXA is most effective when administered early; "time is tissue" applies to hemorrhage control in trauma settings. * **Off-Label:** Frequently used topically in orthopedic surgery or for localized epistaxis (via nasal packing). *** *Disclaimer: This information is for educational purposes only. Clinical protocols, availability, and dosing guidelines vary by institution and patient-specific factors. Always verify current prescribing information in an official database (e.g., Lexicomp, Micromedex) or consult local hospital policy before administration.*