From the Guidelines
The recommended dosage of Tranexamic acid (TXA) for uterine hemorrhage is 1 gram intravenously, with a second dose of 1 gram intravenously if bleeding continues after 30 minutes, or if bleeding restarts within 24 hours of completing the first dose. This is based on the updated WHO recommendation on intravenous tranexamic acid for the treatment of post-partum haemorrhage, which supports treatment with tranexamic acid at a fixed dose of 1 g (100 mg/mL) intravenously at 1 mL/min (i.e., given over 10 minutes) 1. The WOMAN trial, a large international study, demonstrated that TXA administration within 3 hours of onset of postpartum hemorrhage reduced mortality due to bleeding, with a number needed to treat of 276 1. The AAGBI guidelines also recommend an initial dose of 1 g of TXA for severe postpartum hemorrhage (> 500 ml after a vaginal delivery and > 1000 ml after a caesarean delivery) 1. It is essential to note that TXA should be given as soon as possible, ideally within 3 hours of birth, as delay in treatment appears to reduce benefit, decreasing by 10% for every 15 min delay, and with no benefit seen after 3 h 1.
- Key considerations:
- TXA should be given in all cases of post-partum haemorrhage, regardless of whether the bleeding is thought to be due to genital tract trauma or for other reasons, including uterine atony 1.
- The sequential use of interventions for post-partum haemorrhage should start with less invasive interventions, moving towards more invasive interventions as required, and TXA should be considered as part of the standard treatment packages for post-partum haemorrhage 1.
- Health facilities in which emergency obstetric care is provided need to have the necessary supplies and the necessary training for staff who attend births, so that tranexamic acid can be given safely by intravenous infusion 1.
From the FDA Drug Label
Dosage Information
The dosage of Tranexamic acid (TXA) for uterine hemorrhage is as follows:
- Injection: 1,000 mg tranexamic acid, USP (100 mg/mL) clear and colorless solution in 10 mL single-dose vials, as stated in the FDA drug label 2
Administration
According to the FDA drug label, the specific administration instructions for Tranexamic acid (TXA) are not provided in the given text. However, the dosage form and strength are specified as:
- 1,000 mg tranexamic acid, USP (100 mg/mL) in 10 mL single-dose vials 2
From the Research
Dosage of Tranexamic Acid for Uterine Hemorrhage
- The recommended dosage of tranexamic acid (TXA) for uterine hemorrhage is 1g intravenously, with a second dose of 1g if bleeding continues 3.
- The World Health Organization (WHO) recommends that women with post-partum haemorrhage receive 1g TXA intravenously as soon as possible after giving birth, followed by a second dose if bleeding continues after 30 minutes or restarts within 24 hours since the first dose 4.
- The effectiveness of TXA is greatest when administered within 3 hours of childbirth, with a relative risk of 0.69 (95% CI 0.52-0.91) 4.
- There is no benefit to administering TXA more than 3 hours after bleeding onset 4.
Administration and Safety
- TXA should be administered intravenously, with a peak plasma concentration reached within 3 minutes (range: 1-6.6 minutes) 5.
- Low-dose TXA (5mg/kg) inhibits maximum lysis for at least 1 hour, based on ex-vivo pharmacodynamic data 5.
- Patient safety initiatives should be prioritized to prevent maternal death from accidental intrathecal TXA injection from look-alike medication errors 5.