What is the dose of Tranexamic Acid (TXA)?

From the Guidelines

The recommended dose of tranexamic acid (TXA) for trauma patients with significant bleeding is 1 gram administered intravenously over 10 minutes, followed by another 1 gram over 8 hours, and should be given as soon as possible, if feasible en route to the hospital, and within 3 hours after injury. This recommendation is based on the most recent and highest quality study, which suggests that early administration of TXA can significantly reduce the risk of death due to bleeding in trauma patients 1. The study also recommends that the administration of TXA should not await results from a viscoelastic assessment, and that protocols for the management of bleeding patients should consider administration of the first dose of TXA en route to the hospital.

Some key points to consider when administering TXA include:

• The dose of TXA should be given as soon as possible, with earlier administration providing greater benefit 1
• The administration of TXA should not be delayed, and should be given within 3 hours after injury 1
• TXA works by inhibiting plasminogen activation, which prevents the breakdown of blood clots and reduces bleeding
• Dose adjustments may be necessary for patients with renal impairment, although this is not explicitly stated in the most recent guideline 1

It's worth noting that while other studies, such as the 2013 European guideline, also recommend the use of TXA in trauma patients with significant bleeding, the most recent guideline from 2023 provides the strongest and most up-to-date evidence for the recommended dose and administration of TXA 1. Therefore, the recommendation to use 1 gram of TXA administered intravenously over 10 minutes, followed by another 1 gram over 8 hours, is based on the highest quality and most recent evidence available.

From the FDA Drug Label

1. DOSAGE & ADMINISTRATION 2.1 Recommended Dosage The recommended dose of tranexamic acid injection is 10 mg/kg actual body weight intravenously administered as a single dose, immediately before tooth extractions.

The recommended dose of tranexamic acid (TXA) is 10 mg/kg actual body weight, administered intravenously.

• The dose may be repeated 3 to 4 times daily for 2 to 8 days after tooth extraction.
• For patients with moderate to severe renal impairment, a dose reduction is recommended 2.

From the Research

Dose of Tranexamic Acid (TXA)

• The usual evaluated intravenous doses of TXA range between 10mg/Kg and 20mg/kg or a fixed dose of 1g to 2g 3.
• Topical administration of TXA varies between 250 mg and 3g 3.
• Low-dose (250-500 mg) topical TXA reduced postoperative blood loss more effectively compared to high-dose TXA (1-3 g) 4.
• Low-dose intravenous infusion of TXA was the most preferable delivery method, which was as effective as high-dose regimen in reducing transfusion rate without increasing the risk of seizure 5.
• The most frequently used dose of TXA was 15 mg/kg 6.

Administration Methods

• TXA can be administered intravenously or intra-articularly 3.
• Topical application of TXA may be safer, but studies are needed to confirm this 3.
• Intravenous delivery of TXA, either as bolus injection alone or bolus plus continuous infusion, was effective in reducing transfusion requirement 5.

Efficacy and Safety

• TXA significantly reduced transfusion rate, peri-operative blood loss, and re-operation rate 5.
• TXA usage did not increase risk of mortality, myocardial infarction, stroke, pulmonary embolism, and renal dysfunction, but was associated with a significantly increased risk of seizure attack 5.
• A single preoperative dose of intravenous TXA reduced perioperative blood loss and transfusion requirements in a variety of surgical disciplines without increasing the risk of thromboembolic events 6.