From the Guidelines
The appropriate dose of tranexamic acid (TXA) for managing uterine bleeding is 1 g intravenously, with a possible second dose of 1 g if bleeding continues or restarts.
Dosage Regimen
- The initial dose of 1 g should be administered intravenously at a rate of 1 mL/min, which is equivalent to giving the dose over 10 minutes 1.
- A second dose of 1 g can be given if bleeding continues after 30 minutes or if bleeding restarts within 24 hours of completing the first dose 1.
Clinical Context
- Tranexamic acid should be given in all cases of post-partum haemorrhage, regardless of the cause of bleeding, including uterine atony or genital tract trauma 1.
- The treatment is recommended for women with clinically diagnosed post-partum haemorrhage, defined as a blood loss of more than 500 mL after vaginal birth or 1000 mL after caesarean section, or any blood loss that compromises haemodynamic stability 1.
Timing of Administration
- The administration of tranexamic acid should occur as early as possible, ideally within 3 hours of birth or onset of bleeding 1.
- The experts suggest that in a patient presenting with post-partum haemorrhage outside of a specialized structure, intravenous administration of 1 g of tranexamic acid should be done at most 1 to 3 hours after bleeding onset 1.
The FDA Drug Labels for tranexamic acid (PO) do not address this question.
From the Research
Appropriate Dose of Tranexamic Acid for Managing Uterine Bleeding
The appropriate dose of tranexamic acid (TXA) for managing uterine bleeding can vary depending on the specific condition being treated.
- For postpartum haemorrhage, a dose of 1 g of TXA given within 15 min of the umbilical cord being clamped has been studied 2.
- For vaginal delivery, a dose of 10 mg/kg infusion of TXA has been shown to reduce the amount of bleeding after delivery 3.
- For heavy menstrual bleeding, the recommended oral dosage is 3.9-4 g/day for 4-5 days starting from the first day of the menstrual cycle 4.
- For dysfunctional uterine bleeding, a dose of 2 g/day TXA has been found to be effective and safe 5.
Comparison of Different Doses
- A study comparing 500 mg and 1000 mg doses of topical TXA for the treatment of anterior epistaxis found that the 1000 mg dose was more effective in reducing bleeding frequency and rebleeding status 6.
- However, it is essential to note that the optimal dose of TXA for managing uterine bleeding may vary depending on the individual patient and the specific condition being treated.
Safety and Efficacy
- TXA has been shown to be safe and effective in reducing bleeding in various conditions, including postpartum haemorrhage, heavy menstrual bleeding, and dysfunctional uterine bleeding 2, 3, 4, 5.
- The most common adverse effects of TXA are mild and include nausea, vomiting, and diarrhea 4.
- There is no evidence to suggest that TXA increases the risk of thrombotic events, but it is contraindicated in patients with active thromboembolic disease or a history of thrombosis or thromboembolism 4.