From the Guidelines
The recommended dose of tranexamic acid for adults with significant bleeding due to trauma is 1 gram (1000 mg) administered intravenously over 10 minutes, followed by another 1 gram infused over 8 hours, as supported by the most recent and highest quality study 1. This dosing regimen is based on the CRASH-2 trial, which demonstrated a significant reduction in all-cause mortality and death due to bleeding in trauma patients who received tranexamic acid within 3 hours of injury. Key points to consider when administering tranexamic acid include:
- The medication should be given as early as possible to the trauma patient who is bleeding or at risk of significant hemorrhage.
- The loading dose should be infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 hours.
- Tranexamic acid should not be given more than 3 hours following injury, as treatment given after this time may increase the risk of death due to bleeding.
- Protocols for the management of bleeding patients should consider administration of the first dose of tranexamic acid en route to the hospital or at the pre-hospital site of injury.
- The use of tranexamic acid has been shown to be safe and effective in reducing bleeding in trauma patients, with no significant increase in thromboembolic events or other adverse effects, as reported in the study 1.
From the FDA Drug Label
The recommended dose of Tranexamic acid is 10 mg/kg actual body weight intravenously administered as a single dose, immediately before tooth extractions. Following tooth extraction, Tranexamic acid may be administered for 2 to 8 days at a dose of 10 mg/kg actual body weight 3 to 4 times daily, intravenously. For patients with moderate to severe impaired renal function, the following dosages are recommended: Table 1. Recommended Dosage in Patients with Varying Degrees of Renal Impairment Serum Creatinine (mg/dL) Tranexamic acid IntravenousDosage 1.36 to 2.83 (120 to 250 micromol/L) 10 mg/kg twice daily 2.83 to 5. 66 (250 to 500 micromol/L) 10 mg/kg daily
5.66 (>500 micromol/L) 10 mg/kg every 48 hours or 5 mg/kg every 24 hours
The recommended tranexamic acid dose is 10 mg/kg actual body weight intravenously administered as a single dose, immediately before tooth extractions.
- For patients with normal renal function, the dose is 10 mg/kg 3 to 4 times daily, intravenously, for 2 to 8 days following tooth extraction.
- For patients with renal impairment, dose reduction is recommended, with specific dosages based on serum creatinine levels, as outlined in Table 1 [2] [3]. Key considerations for dosing include:
- Actual body weight
- Renal function
- Intravenous administration
- Dose reduction for renal impairment
From the Research
Tranexamic Acid Dose
- The ideal dose of tranexamic acid (TXA) is not explicitly stated in the provided studies, but its administration has been shown to reduce blood loss and transfusion rates in various surgical procedures 4, 5, 6.
- A study on the routine use of TXA in hip and knee replacements found that 1 gram of intravenous TXA administered at the time of induction significantly reduces operative blood loss and transfusion rates 6.
- The pharmacokinetics of TXA have been studied, and it has been found that oral and intramuscular bioavailabilities are 46 and 105%, respectively 7.
- However, the administration of high doses of TXA has been associated with seizures and other adverse effects, highlighting the need for standardized dosing 4.
- The effectiveness of TXA in reducing blood transfusion has been demonstrated in various studies, including those on total hip replacement 5 and upper gastrointestinal bleeding, but its effect on lower gastrointestinal bleeding is less clear 8.