What is the use of Tranexamic acid (TXA)?

From the Guidelines

Tranexamic acid should be administered to trauma patients who are bleeding or at risk of significant bleeding as soon as possible, with a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 hours, as recommended by the most recent guidelines 1. The use of tranexamic acid is supported by strong evidence from recent studies, including the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1, which provides a Grade 1A recommendation for its use in trauma patients. Key points to consider when using tranexamic acid include:

• Administration should be done as soon as possible, if feasible en route to the hospital, and within 3 hours after injury 1
• The recommended dosing regimen is a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 hours 1
• Tranexamic acid should not await results from a viscoelastic assessment before administration 1
• The medication works by binding to plasminogen and blocking its conversion to plasmin, thereby preventing fibrin degradation and preserving clot stability
• Side effects include nausea, vomiting, diarrhea, and headache, with rare but serious risks of thromboembolism, hypersensitivity reactions, and seizures
• Tranexamic acid should be used cautiously in patients with history of thrombosis, renal impairment, or seizure disorders, and dose adjustments are needed for patients with kidney dysfunction The most recent and highest quality study, the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1, provides the strongest evidence for the use of tranexamic acid in trauma patients, and its recommendations should be followed in clinical practice.

From the FDA Drug Label

Tranexamic acid is an antifibrinolytic indicated in patients with hemophilia for short-term use (2 to 8 days) to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction.

DOSAGE AND ADMINISTRATION • Before Extraction: Administer 10 mg/kg actual body weight of Tranexamic acid injection intravenously with replacement therapy. • After Extraction: Administer 10 mg/kg actual body weight 3 to 4 times daily for 2 to 8 days.

Tranexamic acid use is indicated in patients with hemophilia for short-term use to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction. The recommended dosage is 10 mg/kg actual body weight, administered intravenously before extraction, and 3 to 4 times daily for 2 to 8 days after extraction 2, 2. Key considerations include:

• Short-term use (2 to 8 days)
• Dosage administration before and after tooth extraction
• Contraindications, such as subarachnoid hemorrhage and active intravascular clotting
• Risk of thrombosis, medication errors, and hypersensitivity reactions 2

From the Research

Tranexamic Acid Use

• Tranexamic acid (TXA) is an antifibrinolytic agent used to prevent or treat bleeding in various clinical settings, including surgery, trauma, obstetric complications, and disorders of hemostasis 3.
• The use of TXA has been well-defined in postpartum hemorrhage, menorrhagia, trauma-associated hemorrhage, and surgical bleeding, with accumulating data suggesting its ability to reduce bleeding and improve clinical outcomes without a clear increase in thrombotic risk 3, 4.
• TXA has been shown to reduce major bleeding by 25% without a significant increase in thrombotic events in some surgical interventions, such as cardiac, orthopedic, abdominal, and urologic surgery, cesarean section, and neurosurgery 4.
• The efficacy and safety of TXA vary according to the clinical context, timing of administration, and dose, with some reports indicating a potential benefit in reducing bleeding and improving patient quality of life 5, 6.

Clinical Indications

• TXA is commonly used for the treatment or prevention of bleeding in various clinical settings, including:
  • Heavy menstrual bleeding: TXA has been shown to reduce menstrual blood loss by 34-54% and improve patient quality of life by 46-83% 6, 7.
  • Trauma: TXA has been used to reduce bleeding and improve outcomes in trauma patients 3, 5.
  • Postpartum hemorrhage: TXA has been used to prevent or treat postpartum hemorrhage, with accumulating data suggesting its ability to reduce bleeding and improve clinical outcomes 3, 5.
  • Surgical bleeding: TXA has been used to reduce bleeding and improve outcomes in surgical patients, including those undergoing cardiac, orthopedic, abdominal, and urologic surgery, cesarean section, and neurosurgery 4.

Safety and Efficacy

• TXA has been shown to be safe and effective in reducing bleeding and improving patient quality of life, with no significant increase in thrombotic events reported in most studies 3, 4, 6.
• However, the use of TXA is not without controversy, with some concerns regarding thrombotic risk and potential interactions with other medications 5.