What is the dosing for Tranexamic Acid (TXA)?

From the Guidelines

Tranexamic acid should be administered at a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 hours in patients who are bleeding or at risk of significant hemorrhage, and it is crucial to give it within 3 hours of injury for maximum benefit 1. The dosing of tranexamic acid (TXA) is critical in managing bleeding and coagulopathy following major trauma.

Key Considerations

• The loading dose of 1 g infused over 10 minutes is recommended to rapidly achieve therapeutic levels of TXA.
• The subsequent infusion of 1 g over 8 hours maintains the therapeutic effect and supports the stabilization of clots.
• Early administration of TXA, within 3 hours of injury, is essential for maximizing its benefits in reducing mortality due to bleeding 1.

Clinical Context

In the context of trauma care, the use of TXA has been extensively studied, and its efficacy in reducing death due to bleeding has been demonstrated in large trials like the CRASH-2 study 1.

Dosing and Administration

The standard dosing regimen for TXA in trauma patients involves an initial loading dose followed by a maintenance infusion.

• The loading dose is 1 g infused over 10 minutes.
• The maintenance infusion is 1 g over 8 hours. This regimen is supported by high-quality evidence from studies like the CRASH-2 trial, which showed a significant reduction in all-cause mortality and death due to bleeding in patients receiving TXA compared to those receiving a placebo 1.

Special Considerations

While the primary discussion revolves around the use of TXA in trauma, its application in other areas, such as surgical prophylaxis or menorrhagia, may involve different dosing regimens.

• For surgical prophylaxis, doses of 10-15 mg/kg intravenously before surgery are common.
• In menorrhagia, oral administration of 1300 mg three times daily for up to 5 days during menstruation is a standard approach. However, these considerations are outside the primary scope of trauma care and the use of TXA as an antifibrinolytic agent in acute hemorrhage.

Conclusion is not allowed, so the answer ends here.

From the FDA Drug Label

2.1 Recommended Dosage The recommended dose of Tranexamic acid is 10 mg/kg actual body weight intravenously administered as a single dose, immediately before tooth extractions. Infuse no more than 1 mL/minute to avoid hypotension [see Warnings and Precautions (5.1)]. Following tooth extraction, Tranexamic acid may be administered for 2 to 8 days at a dose of 10 mg/kg actual body weight 3 to 4 times daily, intravenously.

The dosing for Tranexamic Acid (TXA) is:

• 10 mg/kg actual body weight intravenously as a single dose before tooth extractions
• 10 mg/kg actual body weight 3 to 4 times daily intravenously for 2 to 8 days after tooth extraction
• Dose reduction is recommended for patients with moderate to severe renal impairment as follows:
  • 10 mg/kg twice daily for serum creatinine 1.36 to 2.83 mg/dL
  • 10 mg/kg daily for serum creatinine 2.83 to 5.66 mg/dL
  • 10 mg/kg every 48 hours or 5 mg/kg every 24 hours for serum creatinine >5.66 mg/dL 2

From the Research

Tranexamic Acid Dosing

• The optimal dosage of tranexamic acid (TXA) remains a matter of debate, with various studies suggesting different dosing regimens 3, 4, 5, 6, 7.
• A study published in Acta ortopedica mexicana found that a single pre-surgical dose of 1 g TXA reduces hemoglobin loss in patients undergoing total hip and knee arthroplasty (THA and TKA) 3.
• Another study published in Anesthesiology recommends a new dosing regimen for patients with chronic kidney disease, suggesting a bolus infusion of 15 mg/kg over 15 min together with a maintenance infusion of 7.5 mg/kg/h or 5 mg/kg/h for 2 hours for good and poor renal function groups, respectively 4.
• A comparative analysis of TXA dosing strategies in traumatic major hemorrhage found that clinical outcomes and 24-hour fibrinolysis state were equivalent across three different dosing strategies of TXA, with single bolus administration being likely preferable to a bolus plus infusion regimen 5.
• A randomized controlled trial published in Acta orthopaedica Belgica found that a single preoperative dose of 1 g intravenous TXA safely reduces blood loss and transfusion in patients undergoing hip hemiarthroplasty for femoral neck fracture 6.
• A study published in the Bulletin of the NYU hospital for joint diseases found that 1 gram of TXA administered intravenously at the time of induction significantly reduces operative blood loss and transfusion rates in patients undergoing hip and knee replacements 7.

Dosing Regimens

• 1 g TXA 30 minutes before surgery 3
• 1 g TXA at the start of the surgery 6, 7
• 15 mg/kg bolus infusion over 15 min together with a maintenance infusion of 7.5 mg/kg/h or 5 mg/kg/h for 2 hours for good and poor renal function groups, respectively 4
• 1 g bolus only, 1 g bolus + 1 g infusion over 8 hours, or 2 g bolus 5