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# Tranexamic Acid
## Overview
Tranexamic acid is a synthetic derivative of the amino acid lysine. It is an antifibrinolytic agent that inhibits the activation of plasminogen to plasmin, thereby preventing the degradation of fibrin clots.
## Primary Indications
* Hemorrhagic conditions, including heavy menstrual bleeding, epistaxis, gastrointestinal bleeding, and postpartum hemorrhage.
* Reduction of blood loss during and after surgery (e.g., cardiac, orthopedic, gynecological surgery).
* Management of bleeding due to increased fibrinolysis.
## Adult Dosing
* **Heavy Menstrual Bleeding:** 1000 mg (e.g., 2 tablets of 500 mg) three times daily for a maximum of 4 days during menstruation.
* **Surgical/Traumatic Bleeding:**
* **Perioperative:** A common regimen is an initial bolus dose of 10-15 mg/kg, followed by an infusion of 1-2 mg/kg/hour. Doses may vary significantly based on surgical procedure and institutional protocol.
* **Acute Bleeding:** Doses can range from 1000 mg IV every 6-8 hours, but specific dosing may vary.
* **Epistaxis:** 1000-1500 mg orally three times daily for 3-4 days. Some protocols may use IV or topical routes.
## Pediatric Dosing
* Dosing in pediatric patients is not well established and should be considered highly individualized based on weight and indication.
* Some studies suggest doses of 10-25 mg/kg/dose IV or orally every 6-8 hours.
* Use in neonates for conditions like intraventricular hemorrhage is controversial and requires specialized consultation.
## Dose Adjustments
* **Renal Impairment:** Dose reduction is necessary in patients with significant renal impairment.
* Creatinine Clearance (CrCl) 50-80 mL/min: 2000 mg daily in 2 divided doses.
* CrCl 10-50 mL/min: 1000 mg daily.
* CrCl <10 mL/min: 1000 mg every other day.
* Dosing may be adjusted based on specific laboratory values and clinical response.
## Contraindications
* Active intravascular clotting or thrombosis (e.g., deep vein thrombosis, pulmonary embolism, arterial thrombosis).
* Acquired defective color vision.
* Subarachnoid hemorrhage (risk of cerebral edema and infarction).
* Hypersensitivity to tranexamic acid or any component of the formulation.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Thrombotic events (deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke), hypersensitivity reactions, visual disturbances (including color vision changes), hypotension (especially with rapid IV infusion).
## Key Drug Interactions
* **Hormonal contraceptives:** Increased risk of thrombosis. Avoid co-administration if
