What is the effect of Txa (tranexamic acid)?

From the Guidelines

Tranexamic acid (TXA) should be administered as early as possible to trauma patients who are bleeding or at risk of significant hemorrhage, with a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 h, to reduce mortality and improve outcomes 1. The use of TXA has been extensively studied in various clinical settings, including trauma care, surgical settings, and management of heavy menstrual bleeding. The medication works by inhibiting the breakdown of blood clots, thereby promoting clot stability and reducing blood loss.

• The typical adult dosage for intravenous administration is 1 gram given over 10 minutes, which can be repeated after 8 hours if bleeding continues.
• For oral use, such as for menorrhagia, the usual dose is 1300 mg three times daily for up to 5 days during menstruation.
• Side effects may include nausea, vomiting, diarrhea, and rarely, thromboembolic events.
• TXA should be used with caution in patients with a history of blood clots or kidney dysfunction, as the drug is primarily eliminated through the kidneys and dosage adjustments may be necessary for patients with renal impairment. The most recent and highest quality study, published in 2023, confirms the efficacy of TXA in reducing mortality in trauma patients, particularly when administered early, within 3 hours of injury 1.
• The study found that early treatment with TXA reduced the risk of head injury-related death and was highly cost-effective for mild and moderate head injury.
• Another study published in 2022 also recommends the use of TXA to reduce blood loss and the need for transfusion in hip fracture patients 1. Overall, the evidence supports the use of TXA as a valuable medication in reducing morbidity, mortality, and improving quality of life in patients with significant bleeding or at risk of hemorrhage.

From the Research

Effects of Tranexamic Acid (TXA)

• TXA is an antifibrinolytic agent that has been used to treat various types of bleeding, including dysfunctional uterine bleeding, traumatic extracranial hemorrhage, anterior epistaxis, and dental procedures on patients with hemophilia 2.
• It has been shown to be effective in achieving hemostasis in patients on direct oral anticoagulants (DOACs) who are at risk of bleeding 2, 3.
• TXA has been used to reduce bleeding and improve clinical outcomes in a wide range of clinical settings, including surgery, trauma, and obstetric complications 4, 5.
• The use of TXA has been associated with a reduced risk of major bleeding in some studies, without a significant increase in thrombotic events 5.
• However, the safety and efficacy of TXA may vary depending on the clinical context, timing of administration, and dose 5, 6.

Clinical Indications for TXA

• TXA has been used to treat bleeding in various clinical settings, including:
  • Postpartum hemorrhage
  • Menorrhagia
  • Trauma-associated hemorrhage
  • Surgical bleeding
  • Gastrointestinal bleeding
  • Epistaxis
• It has also been used in patients with hemophilia and those on anticoagulant therapy 2, 4, 3.

Safety and Efficacy of TXA

• TXA has been shown to be safe and effective in reducing bleeding in many clinical settings 4, 5.
• However, there is a risk of thrombotic events associated with the use of TXA, particularly if it is given more than 3 hours after traumatic injury 6.
• The optimal timing and dose of TXA administration may vary depending on the clinical context and the individual patient's needs 5, 6.