What is the recommended oral dose of tranexamic acid (TXA) for a patient with spontaneous miscarriage and heavy vaginal bleeding when intravenous (IV) access is not available?

Oral Tranexamic Acid Dosing for Spontaneous Miscarriage with Heavy Vaginal Bleeding

For patients with spontaneous miscarriage and heavy vaginal bleeding without IV access, administer 1 gram of oral tranexamic acid as soon as possible after bleeding onset (within 3 hours), with a second 1 gram dose if bleeding continues after 30 minutes or restarts within 24 hours of the first dose. 1

Dosing Regimen

• Administer 1 gram of oral tranexamic acid as the initial dose 1
• Give a second 1 gram dose if bleeding continues after 30 minutes or restarts within 24 hours 1
• Treatment must be initiated within 3 hours of bleeding onset for maximum effectiveness 1
• Early administration is critical, as effectiveness decreases by approximately 10% for every 15-minute delay 1

Clinical Considerations

• While IV administration is preferred when available, oral administration can be used when IV access is not possible 1, 2
• The oral bioavailability of tranexamic acid ranges from 36-67%, so oral dosing should match the IV recommendation of 1 gram 3
• Tranexamic acid works by inhibiting the breakdown of blood clots, helping to control bleeding 2
• Tranexamic acid is most effective when given early - there is no benefit when given more than 3 hours after bleeding onset 2

Contraindications

• Active thromboembolic disease 4, 1
• History of thrombosis or thromboembolism 4, 1
• Intrinsic risk factors for thrombosis or thromboembolism 4, 1
• Known thromboembolic events during pregnancy 1

Monitoring and Follow-up

• Monitor vital signs and bleeding after administration 5
• If bleeding continues despite tranexamic acid administration, urgent transfer to a healthcare facility is required 5
• Tranexamic acid should be considered part of a comprehensive approach to managing heavy vaginal bleeding in spontaneous miscarriage 1

Important Clinical Pearls

• Do not delay administration while waiting for laboratory confirmation of hyperfibrinolysis, as early treatment is crucial for effectiveness 1
• Tranexamic acid is cost-effective and heat-stable with a long shelf life 2
• The World Health Organization strongly recommends tranexamic acid for the treatment of significant bleeding following childbirth 5
• Urgent treatment is critical because women with heavy bleeding can deteriorate quickly, and tranexamic acid is most effective when given early 2