What is the use of Tranexamic acid (TXA)?

From the Guidelines

Tranexamic acid should be administered as soon as possible to patients with significant bleeding, ideally within 3 hours of injury, at a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 hours, as this has been shown to reduce mortality due to bleeding 1.

Key Points

• Tranexamic acid is an antifibrinolytic medication that helps control bleeding by preventing blood clots from breaking down.
• The typical intravenous dosing for trauma patients with significant bleeding is a loading dose of 1 gram IV over 10 minutes followed by 1 gram infused over 8 hours.
• Early administration of tranexamic acid, within 3 hours of injury, is crucial in reducing mortality due to bleeding, as evidenced by the WOMAN trial and the CRASH-2 trial 1.
• The medication works by blocking plasminogen activation, which inhibits the breakdown of fibrin clots, making it particularly useful in situations where hyperfibrinolysis contributes to bleeding.

Administration and Dosage

• For trauma patients, the recommended dosage is a loading dose of 1 g infused over 10 min, followed by an i.v. infusion of 1 g over 8 h 1.
• Administration should not await results from a viscoelastic assessment, and should be given as soon as possible, if feasible en route to the hospital 1.

Safety and Efficacy

• Clinical evidence suggests that the risk of thrombosis with tranexamic acid is minimal when used appropriately, although it should be used cautiously in patients with a history of blood clots 1.
• The medication has been shown to be effective in reducing mortality due to bleeding in trauma patients, with a significant reduction in death due to bleeding when administered early 1.

From the FDA Drug Label

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 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 is used to reduce or prevent hemorrhage and the need for replacement therapy in patients with hemophilia during and after tooth extraction. The typical duration of use is 2 to 8 days 2, 2.

• Key uses:
  • Reduce or prevent hemorrhage
  • Reduce the need for replacement therapy
• Target population: Patients with hemophilia
• Specific scenario: During and following tooth extraction
• Duration of use: 2 to 8 days

From the Research

Clinical Indications for Tranexamic Acid

• Tranexamic acid (TXA) is used to prevent and treat bleeding in various clinical settings, including surgery, trauma, obstetric complications, and bleeding disorders 3, 4, 5, 6, 7.
• The drug has been shown to reduce bleeding and improve clinical outcomes in patients with menorrhagia, postpartum hemorrhage, trauma-associated hemorrhage, and surgical bleeding 3, 5, 6.
• TXA is also effective in reducing bleeding in patients undergoing various surgical procedures, such as caesarian section, myomectomy, hysterectomy, orthopedic surgery, cardiac surgery, and skin cancer surgery 5, 6.

Efficacy and Safety of Tranexamic Acid

• The efficacy of TXA in reducing bleeding and improving clinical outcomes has been demonstrated in numerous clinical trials 4, 5, 6.
• The safety profile of TXA is generally favorable, with no significant increase in thromboembolic or seizure events reported in most studies 4, 6.
• However, high doses of TXA may increase the risk of seizures, particularly in patients with brain injury or cardiac surgery 5.
• The optimal dose and timing of TXA administration are still being researched, and there is no consensus on the best approach for different clinical indications 5, 6.

Controversies and Limitations

• Despite the available evidence, there is still hesitancy to use TXA in some clinical settings, partly due to concerns about the risk of thrombosis 7.
• The use of TXA in patients with certain medical conditions, such as spontaneous intracranial bleeding, subarachnoid hemorrhage, or gastrointestinal bleeding, is not recommended due to lack of evidence or potential harm 4, 5.
• Further research is needed to evaluate the optimal dosing and efficacy of TXA in different clinical scenarios, as well as to address the limitations and controversies surrounding its use 6, 7.