What is the role of Tranexamic Acid (TXA) in managing significant bleeding?

From the Guidelines

Tranexamic acid (TXA) should be administered to a patient who is bleeding or at risk of significant bleeding as soon as possible, ideally within 3 hours of injury or bleeding onset, at a loading dose of 1 g infused over 10 min, followed by an intravenous infusion of 1 g over 8 h 1. This recommendation is based on the most recent and highest quality evidence, which suggests that early administration of TXA can reduce mortality in trauma patients with significant hemorrhage. The standard adult dosing regimen is 1 gram IV over 10 minutes, followed by 1 gram infused over the next 8 hours. Some key points to consider when administering TXA include:

• TXA should be administered as soon as possible after bleeding onset, as its effectiveness diminishes significantly when given after 3 hours 1.
• TXA works by blocking the conversion of plasminogen to plasmin, thereby inhibiting fibrinolysis and stabilizing formed clots.
• TXA is particularly useful in trauma, postpartum hemorrhage, menorrhagia, and surgical bleeding.
• While generally safe, TXA should be used cautiously in patients with a history of thromboembolism, seizures, or severe renal impairment, as it may increase thrombotic risk 1. The use of TXA has been shown to be cost-effective, with an estimated incremental cost per life year gained of $48, $66, and $64 in Tanzania, India, and the UK, respectively 1. Overall, TXA is a valuable antifibrinolytic medication that can significantly reduce blood product requirements and improve outcomes in patients with major hemorrhage, and its administration should be prioritized in patients who are bleeding or at risk of significant bleeding.

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 antifibrinolytic effects of tranexamic acid are mediated by reversible interactions at multiple binding sites within plasminogen. Tranexamic acid diminishes the dissolution of hemostatic fibrin by plasmin.

Tranexamic Acid (TXA) can help stop a bleed by reducing or preventing hemorrhage, as it is an antifibrinolytic that works by diminishing the dissolution of hemostatic fibrin by plasmin.

• Key benefits: Reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction in patients with hemophilia.
• Main mechanism of action: Antifibrinolytic effects mediated by reversible interactions at multiple binding sites within plasminogen. 2 2

From the Research

Role of Tranexamic Acid (TXA) in Managing Significant Bleeding

• TXA is an antifibrinolytic agent that reduces blood loss by inhibiting the enzymatic breakdown of fibrin 3
• It is often used in surgery to decrease bleeding and the need for blood transfusion, and has been shown to safely reduce mortality in bleeding trauma patients 3
• The efficacy and safety of TXA for the treatment of bleeding differ according to the clinical context, timing of administration, and dose 4

Clinical Contexts for TXA Use

• TXA is commonly used in the management of postpartum hemorrhage, trauma, and surgical bleeding 4, 5
• It has also been investigated for use in other clinical settings, such as cardiac surgery, neurosurgery, and orthopedic surgery 6
• Early administration of TXA is important for efficacy, particularly in trauma and postpartum hemorrhage 4

Safety and Limitations of TXA Use

• There is no evidence that TXA increases the risk of thrombotic events in patients with major bleeding overall, but there is evidence of increased risk of venous thrombosis in patients with gastrointestinal bleeding 4
• Higher doses of TXA may increase the risk of seizures 4
• The use of TXA outside of the 3-hour window after traumatic injury may be associated with a paradoxical increased risk of death due to bleeding 7