Tranexamic Acid Dosage for Non-Trauma/Non-PPH Indications
For indications other than trauma and postpartum hemorrhage, tranexamic acid is typically administered at a dose of 10 mg/kg intravenously 3-4 times daily, with specific dosing regimens tailored to the particular clinical scenario.
Surgical Settings
- Cardiac and major non-cardiac surgery: Loading dose of 1 g IV over 10 minutes, followed by maintenance dose of 1 g IV over 8 hours 1
- Hemoptysis: Maximum dose of 1 g IV every 8 hours, not exceeding 3 g daily 1
Hemophilia/Dental Procedures
- Tooth extraction in hemophilia patients: 10 mg/kg actual body weight IV as a single dose immediately before extraction, followed by 10 mg/kg 3-4 times daily for 2-8 days 2
- Infuse no more than 1 mL/minute to avoid hypotension 2
Gastrointestinal Bleeding
- Similar dosing to trauma protocol: 1 g IV over 10 minutes followed by 1 g IV over 8 hours 3
- Associated with reductions of 5-54% in mortality compared to placebo in patients with upper GI bleeding 3
Menorrhagia
- Has been used effectively for menstrual blood loss reduction (34-57.9% reduction versus placebo) 3
- Oral administration is typically used for this indication
Dosage Adjustments for Renal Impairment
Renal function significantly impacts TXA clearance, requiring dose adjustment:
| Serum Creatinine (mg/dL) | Tranexamic Acid IV Dosage |
|---|---|
| 1.36 to 2.83 | 10 mg/kg twice daily |
| 2.83 to 5.66 | 10 mg/kg daily |
| >5.66 | 10 mg/kg every 48 hours or 5 mg/kg every 24 hours |
Important Considerations
Timing
- While the 3-hour window is critical for trauma and PPH, this strict timing requirement may not apply to other indications
- For surgical indications, administration is typically started before or during the procedure
Contraindications
- Subarachnoid hemorrhage (may cause cerebral edema and infarction)
- Active intravascular clotting
- Hypersensitivity to tranexamic acid 2
Safety Considerations
- Monitor for potential side effects, including seizures and thrombotic events
- Use with caution in patients with massive hematuria (risk of ureteric obstruction)
- Use with caution in patients using oral contraceptives (increased thrombosis risk) 1
- Avoid concomitant use with pro-thrombotic medical products 2
Route of Administration
- Tranexamic acid is FDA-approved for intravenous use only 2
- Serious adverse reactions including seizures and cardiac arrhythmias have occurred with inadvertent intrathecal administration 2
- While oral administration has approximately 46% bioavailability, intramuscular administration has shown approximately 105% bioavailability in limited studies 4
Clinical Pearls
- TXA is cost-effective across low, middle, and high-income countries 1
- The drug is heat-stable with a long shelf life 5
- For IV infusion, TXA may be mixed with most solutions but should NOT be mixed with blood or solutions containing penicillin 2
- Diluted mixtures may be stored for up to 4 hours at room temperature prior to administration 2
Always ensure the correct route of administration (intravenous only for the injectable form) and monitor patients for potential adverse effects, particularly those with risk factors for thrombotic events.