What is the dose of Tranexamic Acid (TXA)?

Tranexamic Acid Dosing

The standard dose of tranexamic acid is 1g IV over 10 minutes, followed by 1g infusion over 8 hours, which must be administered within 3 hours of bleeding onset for maximum efficacy. 1, 2

Standard Adult Dosing Protocol

Loading dose: 1g (1000 mg) IV administered over 10 minutes 1, 2, 3

Maintenance infusion: 1g IV over 8 hours for procedures expected to exceed 2-3 hours 1

Infusion rate: No more than 1 mL/minute to avoid hypotension 4

Critical Timing Considerations

• Administer within 3 hours of bleeding onset - this is the evidence-based window for maximum efficacy 1, 2
• Effectiveness decreases by 10% for every 15-minute delay in administration 1, 5
• Administration within 1 hour of injury reduces bleeding death by 32% 1
• Administration after 3 hours may paradoxically increase bleeding death risk and should be avoided 1, 2

Context-Specific Dosing Variations

Oral Administration (for chronic bleeding conditions)

• Epistaxis/GI bleeding in HHT: Start at 500 mg twice daily, gradually increasing up to 1000 mg four times daily or 1500 mg three times daily 6
• Contraindications include recent thrombosis; relative contraindications include atrial fibrillation or known thrombophilia 6

Pediatric Dosing (traumatic brain injury)

• Loading dose: 15 mg/kg IV over 10 minutes 5
• Maintenance infusion: 2 mg/kg/hour for 8 hours 5
• Maximum total dose: Do not exceed 100 mg/kg to reduce seizure risk 5

Dental Procedures in Hemophilia Patients

• Single dose: 10 mg/kg actual body weight IV immediately before tooth extraction 4
• Post-extraction: 10 mg/kg 3-4 times daily for 2-8 days 4

Renal Dose Adjustments

TXA is renally excreted and requires dose reduction in renal impairment 1, 4:

• Serum creatinine 1.36-2.83 mg/dL: 10 mg/kg twice daily 4
• Serum creatinine 2.83-5.66 mg/dL: 10 mg/kg once daily 4
• Serum creatinine >5.66 mg/dL: 10 mg/kg every 48 hours OR 5 mg/kg every 24 hours 4

Topical Administration

While IV administration is the evidence-based standard for systemic hemostasis 1, topical TXA can be used for localized bleeding:

• Epistaxis: 1000 mg topical application is superior to 500 mg, with decreased rebleeding rates 7
• Oral bleeding: 500 mg soaked on dressing with direct pressure can achieve hemostasis in anticoagulated patients 8
• Topical agents should only be adjuncts to IV TXA when systemic hemostatic support is needed 1

Key Clinical Pitfalls to Avoid

• Do not delay administration waiting for diagnostic workup or viscoelastic testing - early administration is critical 1, 5
• Do not use topical TXA as a substitute for IV TXA when systemic hemostatic support is needed 1
• Do not administer after 3 hours from bleeding onset, as this may increase mortality 1, 2
• Do not use in patients with active intravascular clotting - this is an absolute contraindication 1, 4
• Monitor for seizures with higher doses, particularly in cardiac surgery or when exceeding 100 mg/kg in pediatrics 1, 5
• Never administer intrathecally - serious adverse reactions including seizures and cardiac arrhythmias have occurred with incorrect route 4

Safety Profile

• No increased risk of arterial or venous thrombotic events demonstrated in over 8,000 patients receiving TXA 1
• Meta-analysis of 125,550 participants confirms safety with no increased thromboembolic risk 1
• Avoid concomitant use with pro-thrombotic medications (Factor IX concentrates, hormonal contraceptives) 4