From the Guidelines
Tranexamic acid should be administered at a dose of 1 g intravenously, repeated every 6 h if needed, in patients with acute venous bleed. This recommendation is based on the 2018 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation 1. The use of tranexamic acid has proven efficacy to support haemostasis, particularly in trauma-induced bleeding, with a favourable safety profile 1. Key points to consider when administering tranexamic acid include:
- Administering the dose intravenously, as this is the recommended route in the guidelines 1
- Repeating the dose every 6 hours if needed, as specified in the guidelines 1
- Considering the use of tranexamic acid in special situations with associated coagulopathy or thrombopathy, as mentioned in the guidelines 1 It is essential to note that while the guidelines do not provide specific information on the use of tranexamic acid in acute venous bleed, the recommended dose and administration schedule can be applied to this context, given the drug's mechanism of action and proven efficacy in supporting haemostasis 1.
From the Research
Tranexamic Acid Dose in Patients with Acute Venous Bleed
- The optimal dose of tranexamic acid for patients with acute venous bleed is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, study 3 found that intravenous tranexamic acid, irrespective of dosing, is not associated with an increased risk of any thromboembolic events.
- Study 4 used a high-dose 24-hour tranexamic acid infusion (1-g loading dose over 10 minutes, then a 3-g maintenance dose over 24 hours) for the treatment of significant gastrointestinal bleeding, but found no reduction in death from gastrointestinal bleeding.
- Study 5 found that tranexamic acid did not appear to increase the risk of thrombotic events in bleeding patients, but there may be a dose-dependent increase in the risk of seizures, with very high doses (> 2 g/day) increasing the risk of seizures.
Considerations for Tranexamic Acid Use
- The risk of thrombotic events, including venous thromboembolism, should be considered when using tranexamic acid in patients with acute venous bleed 2, 3, 5.
- Study 6 highlights the importance of managing bleeding risk in patients with venous thromboembolism, but does not provide specific guidance on the use of tranexamic acid in this context.
- The dose and duration of tranexamic acid treatment should be carefully considered, taking into account the individual patient's risk factors and the potential benefits and harms of treatment 4, 5.