From the Guidelines
Tranexamic Acid (TXA) should be administered at a dose of 1g intravenously over 10 minutes.
Dosing Regimen
- The initial dose of TXA is 1g given intravenously over 10 minutes 1.
- A second dose of 1g intravenously may be given if bleeding continues after 30 minutes, or if bleeding restarts within 24 hours of completing the first dose 1.
- In trauma patients, an additional infusion of 1g over 8 hours may be administered after the initial loading dose 1.
Clinical Context
- TXA should be given as soon as possible, ideally within 3 hours of the onset of bleeding, in patients with post-partum haemorrhage 1 or trauma 1.
- The administration of TXA should not await results from a viscoelastic assessment 1.
- TXA is recommended for use in all cases of post-partum haemorrhage, regardless of the cause of bleeding 1, and in critically ill patients with bleeding or suspected bleeding due to trauma 1.
From the FDA Drug Label
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. Infuse no more than 1 mL/minute to avoid hypotension Following tooth extraction, tranexamic acid injection may be administered for 2 to 8 days at a dose of 10 mg/kg actual body weight 3 to 4 times daily, intravenously.
The appropriate dosing of Tranexamic Acid (TXA) for bleeding is:
- 10 mg/kg actual body weight intravenously as a single dose before tooth extractions
- 10 mg/kg actual body weight 3 to 4 times daily for 2 to 8 days after tooth extraction
- Infusion rate should not exceed 1 mL/minute to avoid hypotension
- Dose reduction is recommended for patients with moderate to severe renal impairment 2 2
From the Research
Appropriate Dosing of Tranexamic Acid (TXA) for Bleeding
The appropriate dosing of Tranexamic Acid (TXA) for bleeding can be summarized as follows:
- A loading dose of 1 g TXA over 10 min followed by an infusion of 1 g over 8 h is a commonly used regimen, as seen in the CRASH-2 trial 3, 4.
- The CRASH-2 trial showed that TXA reduces mortality in bleeding trauma patients, with the greatest benefit when initiated within 3 h of injury 3, 4.
- A study comparing different TXA dosing strategies found that single bolus administration is likely preferable to a bolus plus infusion regimen, with equivalent clinical outcomes across different dosing strategies 5.
- The HALT-IT trial found that a high-dose 24-h infusion of TXA did not reduce death from gastrointestinal bleeding, and may even increase the risk of venous thromboembolic events 6.
- The importance of early treatment with TXA in bleeding trauma patients has been emphasized, with treatment given after 3 h seeming to increase the risk of death due to bleeding 4.
- The safety and effectiveness of TXA use after 3 hours from injury is still unclear, and requires further study 7.
Key Considerations
- The timing of TXA administration is critical, with early treatment (within 3 h of injury) being most effective 3, 4.
- The choice of dosing regimen may depend on the specific clinical context and patient population 5.
- TXA may not be effective for all types of bleeding, such as gastrointestinal bleeding 6.
- Further research is needed to determine the safety and effectiveness of TXA use in certain patient populations, such as polytrauma patients undergoing orthopedic operations 7.