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# Tranexamic Acid ## Overview Tranexamic acid (TXA) is an antifibrinolytic agent that competitively inhibits the activation of plasminogen to plasmin, thereby preventing the degradation of fibrin clots. ## Primary Indications * Treatment/prevention of hemorrhage (trauma, surgery, postpartum hemorrhage). * Heavy menstrual bleeding. * Hereditary angioedema (prophylaxis). ## Adult Dosing * **Trauma (CRASH-2 protocol):** 1 g IV bolus over 10 minutes, followed by 1 g IV infusion over 8 hours. * **Heavy Menstrual Bleeding:** 1.3 g orally three times daily for up to 5 days during menstruation. * **Surgery/General Hemostasis:** 10–20 mg/kg IV bolus, followed by 1–10 mg/kg/hour infusion (highly protocol-dependent). ## Pediatric Dosing * **Trauma:** 15–30 mg/kg IV bolus (max 1 g), followed by 2–10 mg/kg/hour infusion (max 1 g/hr). * *Note: Dosing varies significantly by institutional protocol and indication; consult local pediatric guidelines.* ## Dose Adjustments * **Renal Impairment:** Requires dose reduction in moderate to severe renal insufficiency (CrCl < 50 mL/min). * CrCl 30–50 mL/min: 10 mg/kg twice daily (IV) or 1.3 g once daily (PO). * CrCl 10–30 mL/min: 10 mg/kg once daily (IV) or 650 mg once daily (PO). * CrCl < 10 mL/min: 10 mg/kg every 48 hours (IV) or 650 mg every 48 hours (PO). ## Contraindications * Active intravascular clotting (thrombosis/embolism). * History of venous or arterial thrombosis. * Acquired defective color vision. * Subarachnoid hemorrhage (controversial; risk of cerebral vasospasm). ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal pain (especially with oral formulations). * **Serious:** Thromboembolic events (DVT, PE, MI, stroke), seizures (particularly with rapid IV administration or high doses), visual disturbances, allergic reactions. ## Key Drug Interactions * **Estrogens/Hormonal Contraceptives:** Increased risk of thrombosis. * **Factor IX complex/Prothrombin complex concentrates:** Increased risk of thrombosis. * **Thrombolytics:** Antagonistic effect; avoid concomitant use. ## Monitoring * Monitor for signs of thromboembolism (e.g., calf pain, shortness of breath, chest pain, neurologic changes). * Renal function (baseline and during therapy). * Monitor for seizure activity, particularly in patients with intracranial pathology or those receiving intra-thecal/high-dose IV administration. ## Clinical Pearls * **Seizure Risk:** Rapid IV injection can induce seizures. Infuse over at least 10 minutes. * **Timing:** Efficacy is time-dependent; for trauma, administration within 1–3 hours of injury provides the greatest survival benefit. TXA is generally ineffective if started >3 hours post-injury. * **Topical Use:** TXA is increasingly used topically in orthopedic surgery (e.g., intra-articular) to reduce blood loss with lower systemic absorption. *** **Disclaimer:** This information is for educational purposes only. Clinical protocols vary widely by institution and specialty. Always verify current prescribing information, institutional guidelines, and drug compatibility via official databases (e.g., Lexicomp, UpToDate) or a clinical pharmacist before administration.