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# Tranexamic Acid (TXA) ## Overview Tranexamic acid is an antifibrinolytic agent that competitively inhibits the activation of plasminogen to plasmin, thereby preventing the breakdown of fibrin clots. It is used to manage or prevent excessive bleeding. ## Primary Indications * Treatment of heavy menstrual bleeding (oral). * Short-term use for hemorrhage control in hemophilia (dental surgery). * Treatment or prophylaxis of hemorrhage in trauma (intravenous). * Off-label (common): Perioperative blood loss management, epistaxis, GI hemorrhage, and postpartum hemorrhage. ## Adult Dosing * **Heavy Menstrual Bleeding:** 1,300 mg orally three times daily for up to 5 days during menstruation. * **Trauma (CRASH-2 protocol):** 1 g IV bolus over 10 minutes, followed by 1 g IV infusion over 8 hours. * **Dental Surgery (Hemophilia):** 10 mg/kg IV immediately before surgery, followed by 25 mg/kg orally three to four times daily for 2–8 days. ## Pediatric Dosing * **Trauma/Hemorrhage:** 15–20 mg/kg IV loading dose, followed by 2–10 mg/kg/hour infusion (varies by institutional protocol; follow local guidelines). * **Dental Surgery (Hemophilia):** 10 mg/kg IV pre-operatively, followed by 25 mg/kg orally every 8 hours for 2–8 days. ## Dose Adjustments * **Renal Impairment:** Requires dose reduction or longer dosing intervals. In severe renal impairment (CrCl <30 mL/min), oral doses may require 50% reduction or elimination of every-other dose. Consult package insert for specific CrCl-based adjustments. * **Hepatic Impairment:** No specific adjustment required, but use with caution. ## Contraindications * History of thromboembolic disease (DVT, PE). * Active intravascular clotting. * Acquired defective color vision (prevents monitoring of retinal toxicity). * Subarachnoid hemorrhage (theoretical risk of cerebral ischemia/seizures). * Hypersensitivity to TXA. ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal pain, headache. * **Serious:** Thromboembolic events (DVT, PE, MI, stroke), seizures (especially with high doses or rapid IV administration), visual disturbances (retinal artery/vein occlusion), and allergic reactions. ## Key Drug Interactions * **Combined Hormonal Contraceptives:** Increased risk of thrombotic events. * **Thrombolytics (e.g., tPA):** Concurrent use may negate the efficacy of both agents. * **Factor IX Complex/Anti-inhibitor Coagulant Concentrates:** Increased risk of thrombosis. ## Monitoring * Monitor for signs of thromboembolism (leg swelling, chest pain, dyspnea). * Perform comprehensive ophthalmologic exams (visual acuity, color vision, visual field) for long-term therapy. * Monitor renal function in patients with pre-existing impairment. ## Clinical Pearls * **IV Administration:** Rapid IV injection can cause hypotension; administer slowly over at least 10 minutes. * **Seizure Risk:** High doses, particularly in cardiac surgery or spinal anesthesia, have been associated with increased seizure risk. * **Protocol Dependency:** Dosing for trauma, postpartum hemorrhage, and perioperative use varies significantly by institution; always consult local hospital clinical guidelines. * **Oral Formulation:** Tablets must be swallowed whole; do not crush or chew. *** **Educational Disclaimer:** This information is for educational purposes only. Always consult the most current FDA-approved prescribing information, your institutional pharmacy department, and clinical guidelines before prescribing or administering medication. Dosage in clinical practice must be individualized based on patient-specific factors.