What medication is used to stop active bleeding?

From the Guidelines

Tranexamic acid is the primary medication used to stop active bleeding, given its ability to inhibit the breakdown of blood clots and stabilize clot formation, thereby reducing blood loss. The most recent and highest quality study to guide the use of tranexamic acid in stopping active bleeding is not directly provided in the given evidence, but based on the information available, tranexamic acid works by inhibiting the breakdown of blood clots, helping to stabilize clot formation and reduce blood loss. For adults, the typical dose is 1 gram given intravenously over 10 minutes, followed by another 1 gram over 8 hours if bleeding continues 1. For trauma patients, it's most effective when administered within 3 hours of injury. Other medications that may be used include aminocaproic acid, which works similarly to tranexamic acid, and various topical hemostatic agents like thrombin or fibrin sealants for localized bleeding. In cases of specific deficiencies, such as those induced by anticoagulant medications, the following reversal agents may be indicated:

• For VKA (warfarin), fresh frozen plasma, 4-factor prothrombin complex concentrate (PCC), and vitamin K may be used, with 4-factor PCC having a shorter time to correction of INR and a smaller volume to infuse 1.
• For heparin, protamine sulfate is the reversal agent of choice 1.
• For DOACs (dabigatran, edoxaban, apixaban, rivaroxaban), 4-factor PCC and specific antidotes like idarucizumab for dabigatran may be used 1.
• For platelet inhibitors (aspirin, clopidogrel, prasugrel, ticagrelor), platelet transfusion may be considered, though its effectiveness depends on the timing of the last dose of the medication 1. The choice of medication depends on the cause and location of bleeding, with tranexamic acid being particularly valuable in trauma, surgical, and postpartum hemorrhage due to its broad effectiveness and safety profile. Key considerations in managing bleeding include assessing the patient's hemodynamic status, obtaining a detailed history of anticoagulant use, and employing mechanical compression of bleeding sites when possible, alongside the appropriate use of reversal agents and supportive therapies like fluid replacement and blood transfusion 1.

From the FDA Drug Label

Desmopressin acetate injection will also stop bleeding in hemophilia A patients with episodes of spontaneous or trauma-induced injuries such as hemarthroses, intramuscular hematomas or mucosal bleeding Desmopressin acetate injection will usually stop bleeding in mild to moderate von Willebrand’s patients with episodes of spontaneous or trauma-induced injuries such as hemarthroses, intramuscular hematomas or mucosal bleeding

The medication used to stop active bleeding is desmopressin acetate injection, specifically for patients with:

• Hemophilia A with factor VIII coagulant activity levels greater than 5%
• Mild to moderate von Willebrand’s disease (Type I) with factor VIII levels greater than 5% 2

From the Research

Medication to Stop Active Bleeding

The medication used to stop active bleeding is tranexamic acid (TXA). It is an antifibrinolytic agent that reduces blood loss by inhibiting the enzymatic breakdown of fibrin.

Key Findings

• Tranexamic acid has been shown to reduce mortality due to traumatic bleeding by a third, without apparent safety issues 3, 4.
• It is effective in reducing blood loss in patients with surgical bleeding and the need for transfusion 3, 4.
• The optimal dose of tranexamic acid is 1 g intravenously in an adult patient, with no increased efficacy at higher doses 4.
• Early administration of tranexamic acid is important for efficacy, particularly in trauma and post-partum hemorrhage 3, 5, 6.

Clinical Contexts

• Tranexamic acid is used in various clinical contexts, including:
  • Trauma 3, 5, 4
  • Post-partum hemorrhage 6
  • Surgical bleeding 3, 4
  • Gastrointestinal bleeding 5, 7
• The efficacy and safety of tranexamic acid may differ according to the clinical context, timing of administration, and dose 5.

Safety and Side Effects

• Tranexamic acid has few side effects, except when administered in high doses, where neurological events have been noted 4.
• There is no increased 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 5, 7.
• Seizures have been reported with the use of higher doses of tranexamic acid 7.