What are the doses of Tranexamic acid (TXA)?

From the Guidelines

Tranexamic acid should be administered at a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 hours, as soon as possible to the trauma patient who is bleeding or at risk of significant bleeding, and within 3 hours after injury. This recommendation is based on the most recent and highest quality study, which found that early administration of tranexamic acid reduces the risk of death due to bleeding in trauma patients 1.

Key Considerations

• The dose of tranexamic acid should not be delayed and should be given as soon as possible, if feasible en route to the hospital, and within 3 hours after injury 1.
• The administration of tranexamic acid should not await results from a viscoelastic assessment 1.
• Tranexamic acid works by inhibiting plasminogen activation, which prevents the breakdown of fibrin clots and helps control bleeding.
• Side effects may include nausea, vomiting, diarrhea, and at higher doses, risk of thrombotic events, so caution is advised in patients with history of thromboembolism.

Special Considerations

• In patients with renal impairment, dose adjustments are necessary, with recommendations to reduce the dose by 50% for moderate impairment and by 75% for severe impairment 1.
• Pediatric dosing is weight-based at approximately 10 mg/kg.
• Tranexamic acid can be used in various clinical settings, including surgical settings, post-partum haemorrhage, and major trauma, with a suggested dosing schedule provided in Table 4 of the Association of Anaesthetists guidelines 1.

Evidence Summary

The use of tranexamic acid has been extensively studied, with multiple trials and meta-analyses demonstrating its efficacy and safety in reducing bleeding in various clinical settings 1. The most recent and highest quality study, published in 2023, recommends the use of tranexamic acid in trauma patients who are bleeding or at risk of significant bleeding, as soon as possible and within 3 hours after injury 1.

From the FDA Drug Label

1. DOSAGE & ADMINISTRATION 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 [see WARNINGS AND PRECAUTIONS (5. 1)]. 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 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
• Dose reduction is recommended for patients with moderate to severe impaired renal function 2

From the Research

Tranexamic Acid Doses

• The recommended oral dosage of tranexamic acid for heavy menstrual bleeding is 3.9-4 g/day for 4-5 days starting from the first day of the menstrual cycle 3, 4.
• For adult patients undergoing cardiac surgery, high-dose tranexamic acid (>80 mg/kg total dose) is more effective than low-dose tranexamic acid (<50 mg/kg total dose) in reducing blood loss and improving clinical outcomes 5.
• The efficacy of tranexamic acid in reducing menstrual blood loss has been demonstrated in several studies, with reductions ranging from 26%-60% 3, 34-54% 6, and 40.4% 4.
• Tranexamic acid has been shown to improve health-related quality of life in women with heavy menstrual bleeding, with significant improvements in limitations in social or leisure and physical activities, work inside and outside the home, and self-perceived menstrual blood loss 3, 4.

Dosage Regimens

• High-dose tranexamic acid regimen: 30 mg kg(-1) bolus + 16 mg kg(-1) h(-1) + 2 mg kg(-1) priming 5.
• Low-dose tranexamic acid regimen: 10 mg kg(-1) bolus + 1 mg kg(-1) h(-1) + 1 mg kg(-1) priming 5.
• Oral formulation of tranexamic acid: 3.9 g/d for up to 5 days per menstrual cycle 4.

Safety and Adverse Effects

• Tranexamic acid is generally well-tolerated, with most adverse events being mild to moderate in severity 3, 4.
• The incidence of gastrointestinal adverse events is comparable to placebo 4.
• There is a potential risk of postoperative seizure associated with tranexamic acid use, which is dose-dependent 5.
• No evidence exists of an increase in the incidence of thrombotic events associated with tranexamic acid use in women with heavy menstrual bleeding 3, 6.