What is the use of Tranexamic acid (TXA)?

From the Guidelines

Tranexamic acid should be administered to trauma patients who are bleeding or at risk of significant bleeding as soon as possible, if feasible en route to the hospital, and within 3 hours after injury at a loading dose of 1 gram infused over 10 minutes, followed by an intravenous infusion of 1 gram over 8 hours. This recommendation is based on the most recent and highest quality study available, which suggests that early administration of tranexamic acid can significantly reduce the risk of death due to bleeding in trauma patients 1.

Key Points

• Tranexamic acid works by inhibiting the breakdown of blood clots, thereby promoting clot stability and reducing blood loss.
• The typical adult dosage for tranexamic acid is 1 gram intravenously before surgery or as soon as possible after injury, followed by an intravenous infusion of 1 gram over 8 hours.
• Common uses include trauma with significant bleeding, surgical procedures to reduce blood loss, and heavy menstrual bleeding.
• Side effects may include nausea, vomiting, diarrhea, and headache, while more serious but rare side effects include blood clots.
• Tranexamic acid should be used cautiously in patients with a history of thromboembolism and should not be used in patients with active thromboembolic disease, subarachnoid hemorrhage, or severe renal impairment.

Administration and Dosage

• The administration of tranexamic acid should not await results from a viscoelastic assessment 1.
• A maximum total dose of 100 mg/kg is recommended to minimize the risk of seizures 1.
• The medication takes effect quickly, within 1-2 hours for oral administration and almost immediately when given intravenously.

Clinical Considerations

• Tranexamic acid has been proven to reduce bleeding in most surgical settings, including cardiac and major non-cardiac surgery, major trauma, and postpartum hemorrhage 1.
• The use of tranexamic acid is recommended during on-pump cardiac surgical procedures to reduce blood products transfused and major hemorrhage or tamponade requiring reoperation 1.

From the FDA Drug Label

Tranexamic acid 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. Tranexamic acid 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 (1)

The main use of Tranexamic acid is as an antifibrinolytic in patients with hemophilia for short-term use to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction 2 2.

• Indications: Patients with hemophilia for short-term use (2 to 8 days)
• Key benefits: Reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction.

From the Research

Uses of Tranexamic Acid

• Tranexamic acid is used to treat hyperfibrinolysis, a condition characterized by excessive bleeding due to the breakdown of blood clots 3.
• It is indicated for use in certain conditions with abnormal bleeding or bleeding tendencies, such as heavy menstrual bleeding, postpartum hemorrhage, and bleeding irregularities caused by contraceptive implants 3.
• Tranexamic acid is also used to reduce perioperative blood loss and transfusion requirements in surgical procedures, including cardiac surgery, total hip and knee replacement, and prostatectomy 3.
• It has been shown to be effective in reducing blood loss in gynaecological bleeding disorders, such as menorrhagia and postpartum hemorrhage 4, 5.
• Tranexamic acid is also used to treat trauma-associated hemorrhage, and has been shown to reduce mortality in patients suffering from trauma and postpartum hemorrhage 6, 7.

Mechanism of Action

• Tranexamic acid acts by binding to plasminogen and blocking the interaction of plasmin(ogen) with fibrin, thereby preventing dissolution of the fibrin clot 3.
• It is a synthetic derivative of the amino acid lysine, and is an antifibrinolytic agent 3.

Efficacy and Safety

• Tranexamic acid has been shown to be effective in reducing bleeding in a variety of clinical settings, including surgery, trauma, and bleeding disorders 3, 4, 5, 6, 7.
• It is generally well tolerated, with most adverse events being of mild or moderate severity 3.
• However, there is a risk of thrombotic complications associated with the use of tranexamic acid, particularly in patients with a history of thromboembolic events 7.
• The optimal dose and timing of tranexamic acid administration are still being studied, and there is no consensus on the best approach for many indications 7.