What is the recommended dose of Tranexamic acid (TXA)?

From the Guidelines

Tranexamic acid should be administered as a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 h, in patients who are bleeding or at risk of significant hemorrhage, as evidenced by the CRASH-2 trial 1. The recommended dosing regimen is based on the updated European guideline for the management of bleeding and coagulopathy following major trauma, which suggests that tranexamic acid be administered as early as possible to the trauma patient who is bleeding or at risk of significant hemorrhage 1. Key points to consider when administering tranexamic acid include:

• The loading dose should be infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 h 1
• Tranexamic acid should be administered within 3 h after injury, as treatment given after 3 h may increase the risk of death due to bleeding 1
• Protocols for the management of bleeding patients should consider administration of the first dose of tranexamic acid en route to the hospital, to ensure early treatment 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, with a significant reduction in the risk of death due to bleeding when treatment is administered early 1.

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 recommended tranexamic acid dose is:

• 10 mg/kg actual body weight intravenously before tooth extractions
• 10 mg/kg actual body weight 3 to 4 times daily intravenously for 2 to 8 days after tooth extraction
• Dose reduction is recommended for patients with renal impairment as follows:
  • Mild to moderate renal impairment: 10 mg/kg twice daily
  • Moderate to severe renal impairment: 10 mg/kg daily
  • Severe renal impairment: 10 mg/kg every 48 hours or 5 mg/kg every 24 hours 2

From the Research

Tranexamic Acid Dose

• The optimal dose of tranexamic acid (TXA) is not consistently defined across different indications and studies 3, 4.
• TXA has been shown to be effective in reducing bleeding in various surgical procedures, including cardiac surgery, orthopedic surgery, and gynecological procedures, but the ideal dose is not specified 3.
• In trauma patients, TXA should be given as early as possible and within three hours of injury to be effective, but the exact dose is not provided 5.
• The use of TXA in patients with bleeding disorders, such as heavy menstrual bleeding, postpartum hemorrhage, and bleeding irregularities caused by contraceptive implants, has been shown to be effective, but the optimal dose is not clearly defined 3, 4.
• High doses of TXA have been associated with an increased risk of seizures, particularly in patients with brain injury and cardiac surgery, highlighting the need for careful dosing 4.
• The risk of thrombotic complications with TXA use is a concern, particularly in patients with gastrointestinal bleeding and trauma, and the optimal dose to minimize this risk is not established 4.

Dosage Considerations

• The dosage of TXA may vary depending on the specific indication, patient population, and clinical context 4.
• Further research is needed to determine the optimal dose and timing of TXA administration to minimize the risk of adverse events, such as seizures and thrombotic complications 5, 4.
• The lack of consensus on the optimal TXA dose highlights the need for additional studies to establish evidence-based guidelines for its use in different clinical settings 4.

Clinical Implications

• TXA has been shown to be effective in reducing mortality in patients with trauma and postpartum hemorrhage, but the optimal dose and timing of administration are critical to its effectiveness 5, 4.
• The use of TXA in surgical procedures, such as orthopedic surgery and cardiac surgery, has been associated with reduced bleeding and transfusion requirements, but the ideal dose is not consistently defined 3, 4.
• The potential benefits and risks of TXA use must be carefully considered in each clinical context, taking into account the specific indication, patient population, and dosage regimen 4.