From the Guidelines
Tranexamic acid is indicated for the treatment of excessive bleeding in trauma patients as soon as possible, if feasible en route to the hospital, and within 3 hours after injury. The standard dose for trauma patients with significant bleeding is 1 gram administered intravenously over 10 minutes, followed by 1 gram infused over 8 hours 1. This recommendation is based on the European guideline on management of major bleeding and coagulopathy following trauma, which suggests that tranexamic acid should be administered as soon as possible to trauma patients who are bleeding or at risk of significant bleeding, with a Grade 1A recommendation. Key points to consider when administering tranexamic acid include:
- The importance of early administration, ideally within 3 hours of injury, as effectiveness decreases with delayed administration 1
- The standard dosing regimen for trauma patients, which includes a loading dose of 1 gram infused over 10 minutes, followed by an intravenous infusion of 1 gram over 8 hours 1
- The potential benefits and harms of tranexamic acid, including its effectiveness in reducing bleeding and the potential risks of thromboembolic events, renal impairment, or seizures 1 It is essential to note that tranexamic acid should be given as part of a comprehensive treatment package for post-partum hemorrhage, including fluid replacement, uterotonics, and monitoring of vital signs 1. Additionally, caution should be exercised in patients with a history of thromboembolic events, renal impairment, or seizures, and treatment should be avoided in women with a clear contraindication to antifibrinolytic therapy 1.
From the FDA Drug Label
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 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 is indicated in patients with hemophilia for short-term use to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction 2 2.
- The indicated use is for short-term periods, specifically 2 to 8 days.
- The primary purpose is to reduce or prevent hemorrhage and the need for replacement therapy.
From the Research
Indications for Tranexamic Acid
Tranexamic acid is indicated for various clinical conditions, including:
- Postpartum hemorrhage: Tranexamic acid reduces deaths due to bleeding with no increase in thromboembolic events, and is most effective when given early, within 3 hours of childbirth 3
- Menorrhagia: Tranexamic acid reduces bleeding in patients with menorrhagia 4
- Surgical bleeding: Tranexamic acid reduces blood loss in a wide range of surgical procedures, including orthopedic surgery, cardiac surgery, and obstetric surgery 5, 6, 4
- Trauma-associated hemorrhage: Tranexamic acid reduces mortality in patients suffering from trauma 4
- Bleeding disorders: Tranexamic acid is effective for reducing bleeding in patients with bleeding disorders, such as those undergoing dental extractions or with idiopathic epistaxis 4
Specific Clinical Settings
Tranexamic acid is also indicated for use in specific clinical settings, including:
- Caesarian section: Tranexamic acid reduces bleeding in patients undergoing caesarian section 4
- Myomectomy and hysterectomy: Tranexamic acid reduces bleeding in patients undergoing myomectomy and hysterectomy 4
- Orthognathic surgery and rhinoplasty: Tranexamic acid reduces bleeding in patients undergoing orthognathic surgery and rhinoplasty 4
- Prostate surgery: Tranexamic acid reduces bleeding in patients undergoing prostate surgery 4
- Liver transplantation and resection: Tranexamic acid reduces bleeding in patients undergoing liver transplantation and resection 4
Timing and Dosage
The timing and dosage of tranexamic acid administration are crucial for its effectiveness and safety:
- Postpartum hemorrhage: The WHO recommends 1g tranexamic acid intravenously as soon as possible after giving birth, followed by a second dose if bleeding continues or restarts within 24 hours 3
- Surgical bleeding: The optimal dose and timing of tranexamic acid administration vary depending on the surgical procedure and patient population 6, 4