From the Guidelines
Tranexamic acid (TXA) should be administered as a 1 g bolus followed by a 1 g infusion over 8 hours. This dosing regimen is based on the most recent and highest quality study, the CRASH-3 trial, which compared this regimen to placebo in patients with traumatic brain injury 1. The study found that early treatment with TXA reduced the risk of head injury-related death, particularly in patients with mild and moderate head injury.
The use of TXA in trauma patients has been extensively studied, and the evidence suggests that it can reduce mortality and bleeding-related complications 1. The typical dosing regimen for TXA in trauma patients is a 1 g bolus followed by an infusion, although the exact duration and dose of the infusion may vary depending on the specific clinical context.
Some studies have suggested that higher doses of TXA may be more effective in reducing bleeding and improving outcomes, but these findings are not consistent across all studies 1. Additionally, there is some evidence to suggest that TXA may be more effective when administered early after injury, particularly within the first hour 1.
In terms of potential side effects, TXA is generally well-tolerated, although seizures have been reported in some cases, particularly with high doses 1. Overall, the evidence suggests that TXA is a safe and effective treatment for reducing bleeding and improving outcomes in trauma patients, and it should be considered as part of a comprehensive treatment strategy.
Key points to consider when administering TXA include:
- The dose and duration of the infusion should be individualized based on the specific clinical context and patient needs
- TXA should be administered as soon as possible after injury, ideally within the first hour
- The patient's coagulation parameters and bleeding status should be closely monitored during treatment with TXA
- TXA should be used in conjunction with other treatments, such as blood transfusions and surgical intervention, as part of a comprehensive treatment strategy.
From the FDA Drug Label
2.1 Recommended Dosage The recommended dose of tranexamic acid injection is 10 mg/kg actual body weight intravenously administered as a single dose, immediately before tooth extractions. Infuse no more than 1 mL/minute to avoid hypotension Before Extraction: Administer 10 mg/kg actual body weight of tranexamic acid injection intravenously with replacement therapy. After Extraction: Administer 10 mg/kg actual body weight 3 to 4 times daily for 2 to 8 days. Infuse no more than 1 mL/minute to avoid hypotension.
The dosage for Tranexamic acid (TXA) infusion is:
- 10 mg/kg actual body weight intravenously administered as a single dose, immediately before tooth extractions
- 10 mg/kg actual body weight 3 to 4 times daily for 2 to 8 days after extraction
- Infusion rate: no more than 1 mL/minute to avoid hypotension 2, 2
From the Research
Dosage for Tranexamic Acid (TXA) Infusion
The dosage for Tranexamic Acid (TXA) infusion varies depending on the specific medical condition being treated.
- For patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), a common dosage is 10 mg/kg followed by an infusion of 1 mg/kg/hour 3.
- For trauma patients, a loading dose of 1 g TXA, administered intravenously as a bolus dose before hospital admission, followed by a 1-g infusion over a period of 8 hours after arrival at the hospital, has been used 4.
- In another study, a loading dose of 1 g TXA was administered intravenously over 10 min, followed by a maintenance dose of 3 g TXA infused at 125 mg/h for 24 h 5.
- For patients receiving prehospital TXA, a second in-hospital dose of 1 g TXA has been investigated, but its efficacy and safety are still being studied 6.
- The CRASH-2 trial used a loading dose of 1 g over 10 min, followed by an infusion of 1 g over 8 h 7.
Specific Dosage Regimens
Different studies have used the following dosage regimens: