From the Guidelines
Tranexamic acid (TXA) is preferred for bleeding management in trauma patients with significant hemorrhage when administered within 3 hours of injury, ideally within the first hour for maximum benefit. The standard dosing is 1 gram IV over 10 minutes, followed by 1 gram infused over the next 8 hours 1. TXA is also indicated for heavy menstrual bleeding, perioperative bleeding prevention in high-risk surgeries, and management of bleeding in hemophilia patients undergoing dental procedures.
Key Points
- TXA works by inhibiting plasminogen activation and preventing fibrinolysis, thereby stabilizing blood clots that have formed.
- It should be used cautiously in patients with a history of thromboembolic events, and dose adjustments are necessary in patients with renal impairment.
- TXA is contraindicated in active thromboembolic disease, subarachnoid hemorrhage, and hypersensitivity to the medication.
- The medication is generally well-tolerated with minimal side effects when used appropriately.
Administration
- The administration of TXA should not await results from a viscoelastic assessment 1.
- TXA should be given as soon as possible, if feasible en route to the hospital, and within 3 h after injury 1.
Benefits
- Early treatment with TXA significantly reduces the risk of death due to bleeding 1.
- The risk of precipitated thrombosis with the use of TXA is lower than expected, and the rate of thrombosis, especially myocardial infarction, was lower with the use of TXA 1.
From the FDA Drug Label
Tranexamic acid injection is 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. 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
Tranexamic acid (TXA) is preferred for bleeding management in patients with hemophilia for short-term use (2 to 8 days) to:
- Reduce or prevent hemorrhage
- Reduce the need for replacement therapy during and following tooth extraction 2, 2.
From the Research
Indications for Tranexamic Acid (TXA) Use
- TXA is preferred for bleeding management in various clinical settings, including:
- TXA has also been shown to be effective in reducing bleeding in patients undergoing:
- Caesarian section 4
- Myomectomy 4
- Hysterectomy 4
- Orthognathic surgery 4
- Rhinoplasty 4
- Prostate surgery 4
- Dental extractions in patients with bleeding disorders or taking antithrombotic drugs 4
- Idiopathic epistaxis 4
- Tonsillectomy 4
- Liver transplantation and resection 4
- Nephrolithotomy 4
- Skin cancer surgery 4
- Burn wounds and skin grafting 4
Timing and Dosage of TXA Administration
- Early administration of TXA (< three hours) may have greater clinical benefits in trauma and obstetrical bleeding 5
- The optimal dose and timing of TXA administration vary depending on the clinical context and indication 4, 5, 6
- High doses of TXA may increase the risk of seizures, particularly in patients with brain injury and cardiac surgery 4
- Delayed administration of TXA for trauma events or postpartum hemorrhage may increase mortality 4
Safety and Efficacy of TXA
- TXA has been shown to reduce bleeding and improve clinical outcomes in various clinical settings without a clear increase in thrombotic risk 3, 4, 5
- However, some studies have reported an increased risk of thrombotic complications with the use of TXA, particularly in patients with gastrointestinal bleeding and trauma 4
- The safety and efficacy of TXA vary depending on the clinical context, timing of administration, and dose 4, 6