What is the recommended dose of Tranexamic acid (TXA) for stopping bleeding per vaginum?

Tranexamic Acid Dosing for Vaginal Bleeding

For postpartum hemorrhage, tranexamic acid should be administered at a fixed dose of 1g intravenously over 10 minutes, with a second dose of 1g if bleeding continues after 30 minutes or restarts within 24 hours of the first dose, and must be given within 3 hours of birth. 1, 2

Dosing Recommendations by Indication

Postpartum Hemorrhage (PPH)

• First-line dose: 1g IV tranexamic acid administered over 10 minutes 1, 2
• Second dose: Additional 1g IV if bleeding continues after 30 minutes or restarts within 24 hours 1
• Critical timing: Must be administered within 3 hours of birth 1, 2
• Indication: All cases of PPH regardless of cause (blood loss >500 mL after vaginal delivery or >1000 mL after cesarean section) 1, 2

Trauma-Related Bleeding

• Loading dose: 1g IV tranexamic acid over 10 minutes 1
• Maintenance dose: 1g IV over 8 hours 1
• Critical timing: Should be administered within 3 hours of injury 1
• Note: Consider protocols for administration en route to hospital 1

Pediatric Dosing for Trauma

• Loading dose: 15 mg/kg IV 1
• Maintenance dose: 2 mg/kg/hour infusion 1

Heavy Menstrual Bleeding

• Oral dosing: 3.9-4g/day (typically 1g four times daily) for 4-5 days starting from first day of menstrual cycle 3, 4
• Alternative regimen: 1.5g three times daily for 5 days for IUD-associated menorrhagia 3

Clinical Considerations

Efficacy

• Tranexamic acid reduces mortality due to bleeding when given early (within 3 hours) 1
• In postpartum hemorrhage, early treatment appears to optimize benefits 1, 5
• For menstrual bleeding, tranexamic acid reduces blood loss by 26-60% 4

Contraindications

• Active thromboembolic disease 3, 6
• In the US, history of thrombosis or intrinsic risk for thrombosis 4
• Should not be administered more than 3 hours after onset of bleeding in trauma or PPH 1

Safety Profile

• Generally well-tolerated with few adverse effects 3, 6
• Most common side effects are gastrointestinal (nausea, vomiting, diarrhea, dyspepsia) 3
• No significant increase in thromboembolic events observed in major clinical trials for PPH 1, 5
• However, in gastrointestinal bleeding, higher risk of venous thromboembolic events has been noted 7

Implementation Pearls

• For PPH, tranexamic acid should be given in all cases regardless of whether bleeding is due to uterine atony, genital tract trauma, or other causes 1, 2
• Tranexamic acid should be part of standard care alongside other treatments like uterotonics 2
• The 3-hour window for administration is critical - efficacy decreases by 10% for every 15-minute delay 1
• For trauma patients, consider including tranexamic acid in pre-hospital protocols 1

Tranexamic acid is a cost-effective, heat-stable medication with a long shelf life, making it practical for various clinical settings 5. Its appropriate use can significantly reduce morbidity and mortality in patients with various types of bleeding, particularly when administered promptly.