What is the dose of tranexamic acid (TXA)?

From the Guidelines

The recommended dose of tranexamic acid for trauma patients is 1 gram IV over 10 minutes, followed by 1 gram IV over 8 hours, as soon as possible and within 3 hours after injury. This dosing regimen is based on the most recent and highest quality evidence from the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1. The guideline recommends that tranexamic acid be administered to the trauma patient who is bleeding or at risk of significant bleeding as soon as possible, if feasible en route to the hospital, and within 3 hours after injury.

Key Points

• The loading dose of 1 gram IV over 10 minutes should be followed by an IV infusion of 1 gram over 8 hours 1.
• Administration of tranexamic acid should not await results from a viscoelastic assessment 1.
• The use of tranexamic acid has been shown to reduce all-cause mortality and the risk of death due to bleeding in trauma patients 1.
• Early treatment with tranexamic acid, within 1 hour of injury, has been shown to significantly reduce the risk of death due to bleeding 1.

Considerations

• Tranexamic acid works by inhibiting plasminogen activation, which prevents the breakdown of fibrin clots and thereby reduces bleeding.
• Side effects can include nausea, vomiting, and diarrhea, with a small risk of thrombotic events, so caution is advised in patients with history of thromboembolism.
• Dosing should be reduced in patients with renal impairment, with specific adjustments based on creatinine clearance.

From the FDA Drug Label

The recommended dose of Tranexamic acid is 10 mg/kg actual body weight intravenously administered as a single dose, immediately before tooth extractions. Following tooth extraction, Tranexamic acid may be administered for 2 to 8 days at a dose of 10 mg/kg actual body weight 3 to 4 times daily, intravenously. For patients with moderate to severe impaired renal function, the following dosages are recommended:

• 1.36 to 2.83 (120 to 250 micromol/L) 10 mg/kg twice daily
• 2.83 to 5. 66 (250 to 500 micromol/L) 10 mg/kg daily

• 1. 66 (>500 micromol/L) 10 mg/kg every 48 hours or 5 mg/kg every 24 hours

The dose of tranexamic acid is 10 mg/kg actual body weight, administered intravenously. The frequency of administration varies depending on the situation:

• A single dose immediately before tooth extractions
• 3 to 4 times daily for 2 to 8 days following tooth extraction
• Adjusted dosing for patients with renal impairment, as outlined in the table 2

From the Research

Dose of Tranexamic Acid

The dose of tranexamic acid (TXA) is a critical aspect of its administration, with various studies examining its efficacy and safety in different clinical settings.

• The optimal dose of TXA has not been universally established, with studies suggesting a range of doses from 1-4 grams intravenously 3, 4.
• A study published in 2022 found that a 2-g dose of TXA had a hazard ratio (HR) of 3.20 for thromboembolic events, while a 4-g dose had an HR of 5.33 4.
• However, a systematic review and meta-analysis published in 2021 found no association between TXA dosing and the risk of venous thromboembolic events 5.
• The use of TXA is likely to continue to rise, with endorsement by various clinical guidelines and healthcare organizations, and further research is needed to evaluate optimal dosing and drug efficacy in different clinical scenarios 3.

Clinical Considerations

When administering TXA, several clinical considerations must be taken into account, including:

• The timing of administration, with early administration (< three hours) potentially having greater clinical benefits in trauma and obstetrical bleeding 3.
• The route of administration, with intravenous administration being the most common 3, 4.
• The patient's individual risk factors for thromboembolic events, such as body mass index and total blood products transfused 4.
• The potential for TXA to be used in conjunction with other medications, such as combined hormonal contraceptives 6.

Safety and Efficacy

The safety and efficacy of TXA have been extensively studied, with the majority of evidence suggesting that it is a safe and effective agent for the prevention and treatment of bleeding.

• A systematic review and meta-analysis published in 2021 found that TXA was associated with a significant reduction in overall mortality and bleeding mortality, but not with non-bleeding mortality 5.
• The same study found no association between TXA and the risk of vascular occlusive events, including venous thrombosis, pulmonary embolism, and cerebral infarction 5.
• However, a study published in 2022 found a dose-dependent increase in the risk of thromboembolic events with TXA, highlighting the need for careful consideration of the risks and benefits of TXA administration 4.