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# Tranexamic Acid ## Overview Tranexamic acid is an antifibrinolytic agent. It competitively inhibits the activation of plasminogen to plasmin, a key enzyme responsible for fibrinolysis. ## Primary Indications * Treatment of oropharyngeal hemorrhage (e.g., following dental extractions in patients with bleeding disorders or heavy menstruation). * Prevention and treatment of bleeding associated with hyperfibrinolysis. * Reduction of blood loss in surgical patients. ## Adult Dosing * **Oropharyngeal bleeding:** 25 mg/kg orally every 4-6 hours. Maximum dose: 1.5 to 2 grams (1500-2000 mg) per dose. * **Surgical blood loss reduction:** Typically given intravenously. Dosing varies significantly based on surgical procedure and hospital protocol. A common regimen involves a loading dose followed by a continuous infusion. For example: * Loading dose: 1 gram IV over 15-30 minutes before incision. * Maintenance infusion: 1 gram IV per hour for the duration of the surgery. * **Maximum dose:** Total daily dose should not exceed 4-6 grams unless otherwise directed by protocol or specialist guidance. ## Pediatric Dosing Limited data exists for pediatric use. Dosing is often based on adult recommendations extrapolated to weight. * **Oropharyngeal bleeding:** 25 mg/kg orally every 4-6 hours. Maximum dose: 1 to 1.5 grams (1000-1500 mg) per dose. ## Dose Adjustments * **Renal Impairment:** Dose reduction is required. Consult specific guidelines or renal dosing calculators as dosage is based on creatinine clearance (CrCl). * CrCl 50-80 mL/min: Consider reducing dose by 50%. * CrCl 10-50 mL/min: Consider halving usual dose and doubling dosing interval or significantly reducing dose. * CrCl <10 mL/min: Consider reducing dose by 90% and extending dosing interval. ## Contraindications * Active intravascular clotting or thrombosis. * Acquired defective color vision. * Hypersensitivity to tranexamic acid. * Subarachnoid hemorrhage (associated with increased risk of vasospasm and infarction). ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, dizziness, headache. * **Serious:** Thrombotic events (deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke), allergic reactions, visual disturbances, seizures, hypotension (with rapid IV infusion). ## Key Drug Interactions * **Hormonal contraceptives (including patches, rings, implants, and IUDs):** Increased risk of thromboembolic events when used concurrently. * **Factor VIIa:** Concomitant use may increase the risk of thrombosis. * **Antifibrinolytics:** Avoid concurrent use due to cumulative risk of thrombosis. * **Estrogens:** May potentiate thrombotic effects. ## Monitoring * Thromboembolic events (signs and symptoms of DVT, PE, MI, stroke). * Visual changes. * Renal function (for dose adjustments). * Effectiveness in controlling bleeding. ## Clinical Pearls * Administer IV tranexamic acid slowly to avoid hypotension and potential CNS effects. * Use with caution in patients with a history of thromboembolic disease. * Discontinue if signs of thrombosis or visual disturbances occur. * Efficacy in traumatic brain injury is uncertain and debated, use based on specific protocols. *** *This information is intended for healthcare professionals. Always consult the most current prescribing information and local institutional protocols before initiating treatment.*