What are the intravenous (IV) tranexamic acid (TXA) doses?

From the Guidelines

The standard intravenous (IV) dose of tranexamic acid is 1 gram (1000 mg) administered over 10 minutes, followed by a maintenance infusion of 1 g over 8 h, as recommended by the most recent guidelines 1. For trauma patients with significant hemorrhage, this medication should be given within 3 hours of injury for maximum benefit, with earlier administration (within 1 hour) providing the greatest mortality reduction. In postpartum hemorrhage, 1 gram IV is recommended as soon as bleeding is identified, with a second dose of 1 g IV given if bleeding continues after 30 min, or it stopped and restarted within 24 h of the first dose. Tranexamic acid works by inhibiting fibrinolysis, which stabilizes formed clots and reduces bleeding. The medication should be administered slowly to avoid hypotension, and dose adjustments are necessary in patients with renal impairment (reduce dose by 50% for creatinine clearance 30-60 mL/min and by 75% for clearance 10-30 mL/min) 1. Some key points to consider when administering tranexamic acid include:

• The use of tranexamic acid has been shown to reduce bleeding in most surgical settings, including cardiac and major non-cardiac surgery, major trauma, and postpartum hemorrhage 1.
• There is no evidence of an increased risk of thromboembolic complications associated with the use of tranexamic acid, supporting the general safety of the drug 1.
• Tranexamic acid should be used with caution in patients with a history of thromboembolic events or those at high risk of thromboembolism 1. Common side effects include nausea, vomiting, and diarrhea, while seizures are a rare but serious adverse effect. It is essential to follow the recommended dosing schedule for different clinical indications, as outlined in the guidelines 1, to ensure the safe and effective use of tranexamic acid.

From the FDA Drug Label

2.1 Recommended Dosage The recommended dose of tranexamic acid injection is 10 mg/kg actual body weight intravenously administered as a single dose, immediately before tooth extractions. Infuse no more than 1 mL/minute to avoid hypotension Following tooth extraction, tranexamic acid injection may be administered for 2 to 8 days at a dose of 10 mg/kg actual body weight 3 to 4 times daily, intravenously.

The recommended IV tranexamic acid doses are:

• 10 mg/kg actual body weight as a single dose before tooth extractions
• 10 mg/kg actual body weight 3 to 4 times daily for 2 to 8 days after tooth extraction Key considerations:
• Infuse no more than 1 mL/minute to avoid hypotension
• Dose reduction is recommended for patients with moderate to severe renal impairment 2
• The dosage may need to be adjusted based on the patient's renal function 2

From the Research

IV Tranexamic Acid Doses

• The WHO recommends that women with post-partum haemorrhage receive 1 g tranexamic acid intravenously as soon as possible after giving birth, followed by a second dose if bleeding continues after 30 min or restarts within 24 h since the first dose 3.
• A study comparing different tranexamic acid dosing strategies in traumatic major hemorrhage found that 1 g bolus only, 1 g bolus + 1 g infusion over 8 hours, and 2 g bolus had similar clinical outcomes, with no significant difference in 28-day mortality 4.
• A narrative review of tranexamic acid for the prevention and treatment of bleeding in surgery, trauma, and bleeding disorders found that the optimal dose of tranexamic acid is not well established for many indications, and that high doses may increase the risk of seizures and thromboembolic events 5.
• A systematic review and individual patient data meta-analysis of randomized controlled trials found that tranexamic acid reduces the risk of life-threatening postpartum bleeding, with no evidence of an increased risk of thrombosis 6.
• A review of tranexamic acid for the management of obstetric hemorrhage found that limited evidence suggests that prophylactic tranexamic acid reduces blood loss at the time of delivery and decreases transfusion rates in the obstetric population 7.

Dosage Regimens

• 1 g intravenous bolus as soon as possible after giving birth, followed by a second dose if bleeding continues after 30 min or restarts within 24 h since the first dose 3.
• 1 g bolus only, 1 g bolus + 1 g infusion over 8 hours, and 2 g bolus have been compared in traumatic major hemorrhage, with similar clinical outcomes 4.
• The optimal dose and timing of tranexamic acid administration are not well established for many indications, and may vary depending on the specific clinical context 5.