Tranexamic Acid Dosing for Uterine Bleeding
For post-partum hemorrhage, administer 1 gram of tranexamic acid intravenously over 10 minutes as soon as possible within 3 hours of birth, with a second 1 gram dose if bleeding continues after 30 minutes or restarts within 24 hours. 1
Post-Partum Hemorrhage (Most Critical Context)
Initial Dosing
- Give 1 gram IV (100 mg/mL) at 1 mL/min over 10 minutes as soon as post-partum hemorrhage is diagnosed 1
- Post-partum hemorrhage is defined as blood loss >500 mL after vaginal delivery, >1000 mL after cesarean section, or any bleeding compromising hemodynamic stability 1
Second Dose Criteria
- Administer a second 1 gram IV dose if:
- Bleeding continues after 30 minutes from the first dose, OR
- Bleeding restarts within 24 hours of completing the first dose 1
Critical Timing Window
- Must be given within 3 hours of birth onset for benefit 1, 2
- Benefit decreases by 10% for every 15-minute delay in administration 1, 3
- No benefit is seen after 3 hours, and late administration may be harmful 1, 2
- Early administration (within 1 hour) provides maximum mortality reduction 3
Scope of Use
- Give tranexamic acid for ALL cases of post-partum hemorrhage, regardless of cause 1
- This includes bleeding from uterine atony, genital tract trauma, or any other etiology 1
- Tranexamic acid should be part of standard treatment packages, not reserved as rescue therapy when uterotonics fail 1
Heavy Menstrual Bleeding (Non-Obstetric Context)
Oral Dosing for Menorrhagia
- 3.9-4 grams per day orally for 4-5 days starting from the first day of menstruation 4
- Alternative effective regimen: 2 grams per day orally has shown 60.3% reduction in blood loss 5
- Reduces menstrual blood loss by 26-60% compared to baseline 4
- More effective than NSAIDs, oral progestins, or etamsylate for idiopathic heavy menstrual bleeding 4
Clinical Context for Menorrhagia
- Consider as first-line treatment for idiopathic menorrhagia, especially when hormonal treatment is contraindicated or unwanted 6
- Superior efficacy compared to NSAIDs for patients with heavy bleeding due to intrauterine devices 6
Contraindications and Safety
Absolute Contraindications
- Active thromboembolic disease 6, 4
- History of thrombosis or thromboembolism 6, 4
- Intrinsic risk for thrombosis or thromboembolism 6, 4
- Known thromboembolic events during pregnancy 3
Renal Dosing Adjustment
- Adjust dose in patients with impaired renal function based on serum creatinine levels 7
Safety Profile
- No evidence of increased thrombotic events when used appropriately 4, 2
- Adverse effects are generally few and mild 4
Mechanism and Rationale
Tranexamic acid is a synthetic lysine analogue that competitively inhibits plasminogen, thereby reducing fibrinolysis and stabilizing blood clots 3, 8. This mechanism makes it particularly effective in bleeding scenarios where fibrinolysis contributes to ongoing hemorrhage.
Common Pitfalls to Avoid
- Do not delay administration while waiting for laboratory confirmation or other interventions—clinical diagnosis is sufficient 1
- Do not give tranexamic acid more than 3 hours after bleeding onset in post-partum hemorrhage, as this may cause harm rather than benefit 1, 2
- Do not withhold the second dose if bleeding continues or recurs within 24 hours 1
- Do not reserve tranexamic acid only for refractory cases—it should be part of initial standard treatment for post-partum hemorrhage 1