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, and should be given as soon as possible to the trauma patient who is bleeding or at risk of significant hemorrhage, ideally within 3 hours of injury 1. The dosing of tranexamic acid (TXA) is crucial in managing bleeding and coagulopathy following major trauma.

• The recommended dose is a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 hours 1.
• Administration of TXA should be done as soon as possible, ideally within 3 hours of injury, as later administration may be less effective or potentially harmful 1.
• The use of TXA has been shown to reduce all-cause mortality and the risk of death due to bleeding in trauma patients, with no significant increase in thrombotic events 1.
• It is essential to note that TXA should be administered to all patients with trauma and significant bleeding, not just those with major hemorrhage, to maximize its benefits 1.
• The cost-effectiveness of TXA in trauma has been calculated, and it is estimated that the incremental cost per life year gained of administering TXA is relatively low, making it a cost-effective treatment option 1. Some key points to consider when administering TXA include:
• TXA works by inhibiting plasminogen activation, which prevents the breakdown of blood clots and helps maintain clot stability.
• Patients with renal impairment may require dose adjustment, typically reducing the dose by 50% when creatinine clearance is 30-60 mL/min and by 75% when clearance is 10-30 mL/min.
• Common side effects of TXA include nausea, vomiting, and diarrhea, while serious but rare complications include seizures and thrombotic events, particularly at higher doses.

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

Dosing Strategies for Tranexamic Acid (TXA)

• The optimal dosage of TXA remains a matter of debate, with various studies suggesting different dosing regimens 3, 4, 5, 6, 7.
• A study published in 2025 found that a single pre-surgical dose of 1 g TXA reduces hemoglobin loss in patients undergoing total hip and knee arthroplasty 3.
• Another study in 2018 proposed an optimized dosing regimen for trauma patients, suggesting that additional dosing schemes may be necessary to maintain therapeutic levels of TXA 4.
• A 2019 study compared the pharmacokinetics of TXA administered via intravenous, intramuscular, and oral routes, finding that oral and intramuscular bioavailabilities were 46% and 105%, respectively 5.
• A comparative analysis of TXA dosing strategies in traumatic major hemorrhage found that clinical outcomes were equivalent across three different dosing strategies: 1 g bolus only, 1 g bolus + 1 g infusion over 8 hours, and 2 g bolus 6.
• A 2017 study evaluated the safety and efficacy of combined intravenous, topical, and oral TXA administration in total knee replacement, finding that high-dose TXA (>25-50mg/kg) resulted in the smallest decrease in postoperative hemoglobin 7.

Dosage Recommendations

• A single pre-surgical dose of 1 g TXA may be effective in reducing hemoglobin loss in patients undergoing total hip and knee arthroplasty 3.
• For trauma patients, an optimized dosing regimen may involve additional dosing schemes to maintain therapeutic levels of TXA 4.
• The choice of TXA dosing strategy may depend on the specific clinical context and patient population, with further research needed to determine the optimal dosage and administration route 5, 6, 7.