Please check your internet connection and try again.
# Tranexamic Acid
## Overview
Tranexamic acid (TXA) is a synthetic antifibrinolytic agent that competitively inhibits the activation of plasminogen to plasmin, thereby preventing fibrin degradation and stabilizing clots.
## Primary Indications
* **Trauma:** Reduction of mortality in patients with significant hemorrhage (CRASH-2 protocol).
* **Surgery:** Prophylaxis or treatment of excessive bleeding (e.g., cardiac, orthopedic).
* **Heavy Menstrual Bleeding:** Cyclic treatment to reduce blood loss.
* **Dental:** Hemorrhage management in patients with coagulopathies.
* **Epistaxis:** Adjunctive management in refractory cases.
## Adult Dosing
* **Trauma Hemorrhage:** 1g IV bolus over 10 minutes, followed by 1g infusion over 8 hours (initiate within 3 hours of injury).
* **Heavy Menstrual Bleeding:** 1,300 mg PO three times daily for up to 5 days during menses.
* **Dental/Surgical/General Bleeding:** 10–15 mg/kg IV every 6–8 hours.
## Pediatric Dosing
* **Trauma/Acute Hemorrhage:** 15 mg/kg IV bolus (max 1g), followed by 2 mg/kg/hour infusion, or 10–15 mg/kg IV every 6–8 hours.
* **Note:** Dosing varies widely by hospital protocol and clinical indication (e.g., cardiac bypass vs. trauma); verify with institutional guidelines.
## Dose Adjustments
* **Renal Impairment:** Requires significant reduction in dosage or interval based on serum creatinine clearance (CrCl). If CrCl < 30 mL/min, avoid or reduce dose by 50–75%.
* **Hepatic Impairment:** Generally no adjustment required; use with caution.
## Contraindications
* Active intravascular clotting (e.g., DVT, PE, cerebral thrombosis).
* History of thromboembolic disease.
* Subarachnoid hemorrhage (controversial; risk of cerebral ischemia).
* Color vision defects (acquired).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, musculoskeletal pain.
* **Serious:** Thromboembolic events (DVT, PE, MI, stroke), seizures (particularly with rapid IV infusion or high doses), visual disturbances (retinal artery occlusion), and hypersensitivity reactions.
## Key Drug Interactions
* **Thrombolytics/Fibrinolytics:** Concomitant use antagonizes the effect of thrombolytic therapy.
* **Estrogens/Hormonal Contraceptives:** May increase the risk of thrombosis when used with TXA.
* **Factor IX complex/Prothrombin complex concentrates:** Increased risk of thrombosis.
## Monitoring
* Monitor hemoglobin/hematocrit and blood pressure during infusion.
* Assess for clinical signs of thromboembolism (swelling, chest pain, dyspnea).
* Monitor for neurological symptoms if high doses are administered.
## Clinical Pearls
* **Rapid IV Injection Risk:** Rapid bolus administration can cause hypotension and seizures; always administer slowly over at least 10 minutes.
* **Seizure Threshold:** Risk of seizure is increased, especially in patients with a history of epilepsy or those undergoing cardiac surgery.
* **Off-label Use:** Frequently used off-label for traumatic hyphema, epistaxis, and postpartum hemorrhage.
* **Therapeutic Window:** Effectiveness is significantly diminished if administered >3 hours post-injury in trauma scenarios.
***
**Educational Disclaimer:** This information is for educational purposes only. Drug protocols, indications, and dosages vary by institution. Always verify current prescribing information, institutional protocols, and patient-specific factors with verified clinical resources before administering any medication.
