Recommended Dosing of Tranexamic Acid for Various Medical Conditions
For most medical conditions requiring tranexamic acid (TXA), the standard dose is 1 gram intravenously administered over 10 minutes, with condition-specific variations in subsequent dosing and administration schedules. 1
Trauma and Acute Hemorrhage
Traumatic Bleeding
- Initial dose: 1 g IV over 10 minutes
- Follow-up: 1 g IV infusion over 8 hours
- Timing: Must be administered within 3 hours of injury (ideally within 1 hour for maximum benefit) 1, 2, 3
- Caution: Administration after 3 hours may increase mortality risk
Postpartum Hemorrhage
- Initial dose: 1 g IV over 10 minutes
- Follow-up: Second dose of 1 g if bleeding continues after 30 minutes or restarts within 24 hours 4, 1
- Timing: Administer within 1-3 hours of bleeding onset 4
Surgical Applications
Cardiac and Major Non-Cardiac Surgery
- Dosing: 1 g IV over 10 minutes, followed by 1 g over 8 hours 1
- Efficacy: Reduces postoperative blood loss by 29-54% compared to placebo 5
Dental Procedures in Hemophilia Patients
- Pre-procedure: 10 mg/kg IV immediately before tooth extraction
- Post-procedure: 10 mg/kg IV 3-4 times daily for 2-8 days 6
- Administration rate: No more than 1 mL/minute to avoid hypotension 6
Chronic Bleeding Conditions
Heavy Menstrual Bleeding
- Oral dosing: 3.9-4 g/day divided into 3-4 doses
- Duration: 4-5 days starting from first day of menstrual cycle 7
- Alternative regimen: 1.5 g three times daily for 5 days 8
- Efficacy: Reduces menstrual blood loss by 26-60% 7, 8
Hereditary Hemorrhagic Telangiectasia
- For epistaxis: Start at 500 mg twice daily, gradually increasing up to 1000 mg 4 times daily or 1500 mg 3 times daily 4
- For mild GI bleeding: Oral antifibrinolytics (specific dose not stated, but likely similar to epistaxis dosing) 4
Hemoptysis
- Maximum dose: 1 g IV every 8 hours, not exceeding 3 g daily 1
Dosage Adjustments for Renal Impairment
| Serum Creatinine (mg/dL) | Recommended Dosage |
|---|---|
| 1.36 to 2.83 | 10 mg/kg twice daily |
| 2.83 to 5.66 | 10 mg/kg once daily |
| >5.66 | 10 mg/kg every 48 hours or 5 mg/kg every 24 hours |
Important Considerations
Contraindications
- Subarachnoid hemorrhage
- Active intravascular clotting
- Severe hypersensitivity to TXA or its ingredients 1, 6
Adverse Effects
- Common: Nausea, vomiting, diarrhea, allergic dermatitis, giddiness, hypotension 1
- Rare but serious: Seizures, thrombotic events 1
Administration Notes
- For IV infusion, TXA may be mixed with most solutions (electrolytes, carbohydrates, amino acids)
- Do not mix with blood or solutions containing penicillin 6
- Diluted mixture stable for up to 4 hours at room temperature 6
Clinical Pearls
- TXA is highly cost-effective across different income countries 1
- For trauma patients, the timing of administration is critical - efficacy decreases significantly after 3 hours 2, 3
- No evidence of increased thrombotic events with proper use 7
- In postpartum hemorrhage, administration within 3 hours of bleeding onset is essential for mortality reduction 4