Can tranexamic acid (TXA) intravenous (IV) stop bleeding?

Tranexamic Acid for Stopping Bleeding

Intravenous tranexamic acid (TXA) effectively stops bleeding when administered within 3 hours of bleeding onset, with the greatest benefit seen when given as early as possible. 1, 2

Mechanism and Efficacy

• TXA is an antifibrinolytic agent that acts as a competitive inhibitor of plasminogen, reducing fibrinolysis and thereby stabilizing blood clots 3
• Early administration (within 3 hours) significantly reduces mortality due to bleeding in multiple clinical scenarios 2, 4
• The efficacy of TXA decreases by approximately 10% for every 15-minute delay in administration 2, 5

Dosing and Administration

• The standard dose is 1g IV administered over 10 minutes 2, 5
• A second dose of 1g should be given if bleeding continues after 30 minutes or restarts within 24 hours of the first dose 2, 5
• TXA should NOT be administered more than 3 hours after bleeding onset as it may be harmful 2, 5
• For patients with renal impairment, dose adjustment is required based on serum creatinine levels 6, 7:
  • For creatinine 1.36-2.83 mg/dL: 10 mg/kg twice daily 7
  • For creatinine 2.83-5.66 mg/dL: 10 mg/kg daily 7
  • For creatinine >5.66 mg/dL: 10 mg/kg every 48 hours or 5 mg/kg every 24 hours 7

Clinical Applications

• Postpartum Hemorrhage: WHO strongly recommends TXA for treatment of postpartum hemorrhage, regardless of cause (uterine atony or genital tract trauma) 1, 2
• Trauma-Associated Bleeding: TXA reduces mortality by approximately one-third when given within 3 hours of injury 8
• Surgical Bleeding: TXA effectively reduces blood loss and transfusion requirements in various surgical procedures 3, 9
• Gynecological Bleeding: Effective for managing significant gynecological bleeding 6, 10

Important Precautions

• TXA is contraindicated in patients with:
  • Subarachnoid hemorrhage 7
  • Active intravascular clotting 7
  • Hypersensitivity to tranexamic acid 7
• Potential adverse effects include:
  • Seizures (particularly with high doses) 7
  • Visual disturbances (with long-term use) 7
  • Dizziness 7
  • Hypersensitivity reactions 7

Integration with Other Treatments

• TXA should be used as part of a comprehensive treatment approach that includes:
  • Fluid replacement 2
  • Other hemostatic measures appropriate to the clinical situation 2, 5
  • Monitoring of vital signs 2
  • Non-surgical and surgical interventions as needed 2

Common Pitfalls to Avoid

• Delayed Administration: Maximum benefit occurs when TXA is given as early as possible; efficacy significantly decreases after 3 hours 2, 4
• Incorrect Route: TXA is for intravenous use only; inadvertent intrathecal administration has caused serious adverse reactions including seizures and cardiac arrhythmias 7
• Excessive Dosing: Higher doses do not increase efficacy but may increase risk of adverse effects, particularly neurological events 9
• Failure to Adjust for Renal Function: Patients with impaired renal function require dose adjustment 7