What is the use of Tranexamic Acid (TXA)?

From the Guidelines

Tranexamic acid (TXA) should be administered to trauma patients who are bleeding or at risk of significant bleeding as soon as possible, with a loading dose of 1 g infused over 10 min, followed by an i.v. infusion of 1 g over 8 h, as recommended by the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1. The administration of TXA should not await results from a viscoelastic assessment, and it is recommended to be given within 3 h after injury, if feasible en route to the hospital 1. Key points to consider when administering TXA include:

• Loading dose: 1 g infused over 10 min
• Maintenance dose: 1 g infused over 8 h
• Timing: as soon as possible, within 3 h after injury
• Administration route: intravenous The European guideline provides a strong recommendation (Grade 1A) for the use of TXA in trauma patients, emphasizing its importance in managing major bleeding and coagulopathy 1.

From the FDA Drug Label

Tranexamic acid injection is indicated in patients with hemophilia for short-term use (2 to 8 days) to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction. Tranexamic acid injection is an antifibrinolytic indicated in patients with hemophilia for short-term use (2 to 8 days) to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction

The main use of TXA (tranexamic acid) is to reduce or prevent hemorrhage in patients with hemophilia during and following tooth extraction. The recommended duration of use is 2 to 8 days 2 2.

• Indications: Short-term use in patients with hemophilia to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction.
• Dosage: 10 mg/kg actual body weight intravenously with replacement therapy before extraction, and 10 mg/kg actual body weight 3 to 4 times daily for 2 to 8 days after extraction 2.

From the Research

TXA Overview

• TXA, or tranexamic acid, is an antifibrinolytic agent that reduces bleeding by inhibiting the breakdown of blood clots 3
• It is cost-effective and heat-stable with a long shelf life, making it a valuable asset in treating post-partum haemorrhage (PPH) 3

Efficacy of TXA in PPH Treatment

• The WOMAN trial found that TXA reduced deaths due to bleeding with no increase in thromboembolic events, with the greatest effect seen when administered within 3 hours of childbirth (RR = 0.69,95% CI 0.52-0.91) 3
• A systematic review and meta-analysis of randomized controlled trials found that TXA reduces the risk of hysterectomy and does not increase the risk of thrombotic events in women with established PPH after vaginal delivery 4
• The World Health Organization recommends that women with PPH receive 1g TXA intravenously as soon as possible after giving birth, followed by a second dose if bleeding continues after 30 minutes or restarts within 24 hours since the first dose 3

Cost-Effectiveness of TXA

• A cost-effectiveness analysis found that routine TXA administration in the treatment of PPH in the United States is cost-saving, with an estimated annual net cost savings of $11.3 million and 9 maternal deaths averted in 1 year 5
• The analysis also found that giving TXA within 3 hours of delivery would almost triple the cost savings and improve maternal outcomes further 5

High-Dose vs Low-Dose TXA Infusion

• A systematic review and meta-analysis found that high-dose TXA infusion in cardiac surgery patients reduces total blood loss, 24-hour blood loss, and the need for fresh frozen plasma transfusions, but increases the risk of postoperative seizures 6
• The study found no significant differences between high-dose and low-dose TXA regimens for other outcomes such as blood transfusions, hospital/ICU stay, mortality, stroke, myocardial infarction, pulmonary embolism, renal dysfunction, and reoperation 6