From the Guidelines
To stop bleeding, I recommend using a hemostatic medication like tranexamic acid (TXA) at a dose of 1 g i.v., repeated every 6 h if needed, as it has proven efficacy to support haemostasis, particularly in trauma-induced bleeding, with a favourable safety profile 1.
Key Considerations
- For minor cuts, apply direct pressure first, then clean the wound and apply a topical hemostatic agent like QuikClot or a styptic pencil.
- For nosebleeds, pinch the soft part of the nose for 10-15 minutes while sitting upright and leaning slightly forward, then consider using an over-the-counter nasal spray containing oxymetazoline.
- For more serious bleeding, seek emergency medical attention immediately, as injectable or IV tranexamic acid may be needed.
Mechanism of Action
- Tranexamic acid specifically inhibits plasminogen activation, which prevents the dissolution of fibrin clots, allowing them to form and remain stable.
Important Notes
- Persistent bleeding, especially from injuries, surgical sites, or without obvious cause, requires immediate medical attention as it could indicate a serious underlying condition.
- The use of antifibrinolytics, such as tranexamic acid, may be considered in special situations with associated coagulopathy or thrombopathy, as supported by a recent study 1.
- Desmopressin, another pro-haemostatic drug, may be considered in patients presenting for surgery with acquired or inherited von Willebrand factor deficiency, but its efficacy in stopping massive coagulopathic bleeding is limited 1.
From the FDA Drug Label
Desmopressin acetate injection will also stop bleeding in hemophilia A patients with episodes of spontaneous or trauma-induced injuries such as hemarthroses, intramuscular hematomas or mucosal bleeding Desmopressin acetate injection will usually stop bleeding in mild to moderate von Willebrand’s patients with episodes of spontaneous or trauma-induced injuries such as hemarthroses, intramuscular hematomas or mucosal bleeding The medication desmopressin can be used to stop bleeding in certain conditions, including:
- Hemophilia A with factor VIII coagulant activity levels greater than 5%
- Mild to moderate von Willebrand’s disease (Type I) with factor VIII levels greater than 5% 2
From the Research
Stop Bleeding Medication
- Tranexamic acid (TXA) is an antifibrinolytic pharmacologic agent that has been shown to be effective in reducing the incidence of death from blood loss following trauma and major surgery 3, 4, 5.
- The World Health Organization recommends that TXA be part of the standard comprehensive postpartum hemorrhage (PPH) treatment package, and US professional organizations recognize its use as adjunctive treatment for PPH 3, 6.
- Studies have found that TXA reduces the risk of life-threatening postpartum bleeding 4, and is a cost-effective strategy for reducing maternal morbidity and mortality due to PPH 6.
- TXA has been shown to be effective in preventing PPH in women undergoing elective cesarean section (CS) or spontaneous birth, with a decrease in blood loss greater than 400 mL or 500 mL 7.
- The optimal dose and timing of TXA administration are still being researched, with some studies suggesting that early administration (within 3 hours of diagnosis) may be more effective in preventing PPH 6.
- Potential side effects of TXA include nausea, vomiting, and dizziness, but the risk of thromboembolic events is uncertain and requires further investigation 4, 7.
Mechanism of Action
- TXA works by inhibiting the breakdown of fibrin clots, which helps to reduce bleeding and promote hemostasis 5.
- The exact mechanism of action of TXA is still not fully understood, but it is thought to involve the inhibition of plasminogen activators and the stabilization of fibrin clots 5.