From the Guidelines
Tranexamic acid (TXA) is most beneficial in trauma-related bleeding, where it should be administered as a 1 gram intravenous loading dose over 10 minutes, followed by an infusion of 1 gram over 8 hours, as soon as possible and within 3 hours of injury. This recommendation is based on the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1. In cases of upper gastrointestinal (GI) bleeding, the use of TXA is more nuanced, and its effectiveness may vary depending on the underlying cause of bleeding. According to the British Society of Gastroenterology guidelines, there is some evidence to suggest that TXA may be beneficial in acute GI bleeding, with a pooled analysis of several trials showing a 40% risk reduction in mortality 1. However, this benefit was not apparent when the analysis was limited to trials at low risk of bias.
Key Considerations for TXA Administration
- In trauma-related bleeding, TXA should be administered as soon as possible and within 3 hours of injury 1.
- In upper GI bleeding, the use of TXA may be considered, but its effectiveness is less clear, and it should be used as part of a comprehensive approach to bleeding management 1.
- Caution should be exercised in patients with renal impairment, and the dose may need adjustment.
- Side effects can include nausea, vomiting, and rarely, thromboembolic events.
Special Considerations in Cirrhosis
- In patients with cirrhosis and active variceal bleeding, TXA should not be used, as it has been shown to have no beneficial effect and may increase the risk of venous thromboembolic events 1.
- In patients with cirrhosis and active bleeding related to portal hypertension, but not to varices, the use of TXA is not recommended, and correction of coagulopathy should be considered on a case-by-case basis 1.
From the FDA Drug Label
Tranexamic acid injection 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 The recommended dose of tranexamic acid injection is 10 mg/kg actual body weight intravenously administered as a single dose, immediately before tooth extractions.
The type of bleeds that tranexamic acid (TXA) is good for is hemorrhage in patients with hemophilia, specifically to reduce or prevent hemorrhage during and following tooth extraction. The dosage is 10 mg/kg actual body weight intravenously administered as a single dose, immediately before tooth extractions, and may be administered for 2 to 8 days at a dose of 10 mg/kg actual body weight 3 to 4 times daily after tooth extraction 2 2.
- Key points:
- Indicated for patients with hemophilia
- Reduces or prevents hemorrhage during and following tooth extraction
- Dosage: 10 mg/kg actual body weight intravenously administered as a single dose before tooth extractions, and 10 mg/kg actual body weight 3 to 4 times daily after tooth extraction
- Dose reduction is recommended for patients with moderate to severe impaired renal function 2.
From the Research
Indications for Tranexamic Acid (TXA)
- TXA is effective in reducing bleeding in patients with upper gastrointestinal (GI) bleeding, as shown in a systematic review with meta-analysis of randomized clinical trials 3.
- The medication may reduce mortality, continued bleeding, and urgent endoscopic intervention in patients with upper GI bleeding 3, 4.
- TXA is also beneficial in reducing bleeding in trauma-related cases, with a reduction in mortality observed in patients suffering from trauma and postpartum hemorrhage 5.
Dosage and Administration
- The optimal dosage of TXA for upper GI bleeding and trauma-related bleeding is not well established, with varying dosages used in different studies 5, 6.
- High-dose IV TXA may not be effective in reducing mortality or bleeding outcomes and may increase the risk of adverse events such as deep venous thrombosis, pulmonary embolism, and seizures 6.
- Low-dose IV or enteral TXA may be effective in reducing rebleeding and the need for surgery, but more evidence is required to demonstrate its safety 6.