Tranexamic Acid Dosing for Severe Dental Bleeding in a 50 kg Patient
For a 50 kg patient with severe bleeding from dental procedures, administer tranexamic acid 500 mg (10 mg/kg) intravenously as a single dose immediately, infused no faster than 1 mL/minute to avoid hypotension, followed by 500 mg IV 3-4 times daily for 2-8 days as needed. 1
Recommended Dosing Protocol
Immediate Administration
- Initial bolus: 500 mg IV (10 mg/kg × 50 kg = 500 mg) given as a single dose 1
- Infuse at a rate no faster than 1 mL/minute to prevent hypotensive episodes 1
- This should be administered immediately upon recognition of severe bleeding 1
Maintenance Therapy
- Continue with 500 mg IV 3-4 times daily for 2-8 days following the dental procedure 1
- Each maintenance dose should also be 10 mg/kg actual body weight 1
- Duration depends on bleeding control, typically 2-8 days 1
Route of Administration Considerations
Intravenous administration is the FDA-approved and evidence-based route for dental bleeding. 1 While topical application using gauze soaked in tranexamic acid has been studied, it showed limited efficacy—improving hemostasis by only a factor of 1.6 compared to compression alone and is most useful only for mild bloody oozing rather than severe bleeding. 2 For severe bleeding, systemic IV administration is required to achieve therapeutic plasma concentrations of 10 μg/mL necessary to inhibit fibrinolysis effectively. 3
Critical Safety Considerations
Infusion Rate
- Never exceed 1 mL/minute infusion rate to avoid hypotension 1
- For a 500 mg dose in 50 mL solution, this means infusing over at least 50 minutes
Contraindications to Verify
- Active intravascular clotting (absolute contraindication) 1
- Subarachnoid hemorrhage (absolute contraindication) 1
- Known hypersensitivity to tranexamic acid 1
Renal Function Assessment
Check serum creatinine before administration and adjust dosing if renal impairment is present: 1
- Normal renal function (Cr <1.36 mg/dL): Standard dosing of 10 mg/kg 3-4 times daily 1
- Moderate impairment (Cr 1.36-2.83 mg/dL): Reduce to 10 mg/kg twice daily 1
- Severe impairment (Cr 2.83-5.66 mg/dL): Reduce to 10 mg/kg once daily 1
- Very severe impairment (Cr >5.66 mg/dL): Reduce to 10 mg/kg every 48 hours or 5 mg/kg every 24 hours 1
Renal clearance is the primary elimination pathway, and failure to adjust dosing increases risk of neurotoxicity and ocular toxicity. 4
Thromboembolic Risk Management
High-Risk Situations Requiring Caution
- Avoid concomitant use with pro-thrombotic agents including Factor IX concentrates, anti-inhibitor coagulant concentrates, and hormonal contraceptives 1
- Patients on oral contraceptives have increased thrombotic risk when receiving tranexamic acid 3
- Active thromboembolic disease is an absolute contraindication 1
Monitoring and Discontinuation
- Discontinue tranexamic acid as soon as bleeding is adequately controlled to minimize thrombotic risk 3
- The drug should not be continued beyond what is necessary for hemostasis 3
Common Pitfalls to Avoid
Incorrect route of administration: Tranexamic acid injection is for IV use only—serious adverse reactions including seizures and cardiac arrhythmias have occurred with inadvertent intrathecal administration 1
Excessive infusion rate: Rapid infusion can cause hypotension; always respect the 1 mL/minute maximum rate 1
Failure to adjust for renal dysfunction: This is the most common cause of toxicity, as 90% of the drug is renally excreted within 24 hours 4
Relying on topical application alone for severe bleeding: Topical tranexamic acid is only effective for mild bloody oozing, not severe bleeding requiring systemic fibrinolysis inhibition 2, 5
Mixing with incompatible solutions: Do not mix with blood products or penicillin-containing solutions 1
Alternative Dosing Context
While European guidelines have historically suggested 10-15 mg/kg followed by infusion of 1-5 mg/kg per hour for general fibrinolysis management 3, 6, the FDA-approved dosing for dental procedures specifically in hemophilia patients (which represents the most evidence-based approach for dental bleeding) uses the simpler bolus regimen of 10 mg/kg followed by 10 mg/kg 3-4 times daily. 1 This approach is more practical for dental bleeding management and avoids the complexity of continuous infusion.