From the Guidelines
Tranexamic acid (TXA) is indicated for the treatment and prevention of excessive bleeding in trauma patients with significant hemorrhage, ideally within 3 hours of injury at a dose of 1g IV over 10 minutes, followed by 1g over 8 hours, as recommended by the European guideline 1. The primary indications for TXA include:
- Trauma patients with significant hemorrhage, with a recommended dose of 1g IV over 10 minutes, followed by 1g over 8 hours 1
- Postpartum hemorrhage, with a recommended dose of 1g IV within 3 hours of birth 1
- Perioperative bleeding management in major surgeries, particularly cardiac, orthopedic, and spinal procedures, typically at 10-15mg/kg IV
- Menorrhagia, with oral TXA (1000-1300mg three times daily for 3-5 days during menstruation) effectively reducing blood loss
- Hemophilia patients undergoing dental procedures (25mg/kg orally 2-3 times daily)
- Epistaxis management (topical application) The medication works by inhibiting plasminogen activation to plasmin, thereby preventing fibrin degradation and stabilizing clots. TXA is contraindicated in patients with active thromboembolic disease, subarachnoid hemorrhage, or hypersensitivity to the drug. Caution should be exercised in patients with renal impairment, requiring dose adjustment. The use of TXA has been shown to reduce mortality and morbidity in trauma patients, with a significant reduction in death due to bleeding when administered early 1. The cost-effectiveness of TXA in trauma has been calculated, with an estimated incremental cost per life year gained of $48, $66, and $64 in Tanzania, India, and the UK, respectively 1. Overall, TXA is a valuable medication in the management of excessive bleeding, and its use should be considered in various clinical scenarios to improve patient outcomes.
From the FDA Drug Label
Tranexamic acid injection is 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. Tranexamic acid injection 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
The indications for TXA are:
- Reduction or prevention of hemorrhage in patients with hemophilia
- Reduction of the need for replacement therapy during and following tooth extraction 2 2
From the Research
Indications for Tranexamic Acid (TXA)
The indications for TXA are diverse and include:
- Heavy menstrual bleeding 3, 4
- Trauma-associated hemorrhage 3, 4
- Postpartum hemorrhage 3, 4
- Surgical bleeding, including orthopedic procedures such as hip and knee joint replacement 3, 5, 6, 7
- Traumatic brain injury 4
- Bleeding disorders, such as those caused by anticoagulation or disorders of hemostasis 3
Clinical Use of TXA
TXA has been shown to reduce blood loss and improve clinical outcomes in a wide range of surgical procedures, including:
- Orthopedic surgery, such as hip and knee joint replacement 5, 6, 7
- Cardiac surgery 6
- Trauma surgery 3, 6, 4
- Obstetric surgery, including postpartum hemorrhage 3, 4
- Liver transplantation 6
Administration of TXA
TXA can be administered intravenously or topically, with both methods showing efficacy in reducing blood loss and transfusion requirements 7. The topical application of TXA has been shown to have a similar safety and efficacy profile to intravenous administration, with no significant difference in transfusion requirements or blood loss 7.