- Action: Antifibrinolytic agent
- Competitive inhibitor of plasminogen activation to plasmin
- Dosing Availability:
- Ampule of 1 Gm in 10 mL
- Formulations: IV and PO; can use IV as topical
FDA-approved only for:
- Postpartum bleeding
- Periprocedural hemorrhage in hemophiliacs.
More common off-label uses:
- Severely bleeding trauma patient, systolic blood pressure of <90 and/or heart rate > 110 beats/min, or with expected requirement for massive transfusion
- Epistaxis, especially in anticoagulated patients
- Under investigation for use in intracranial hemorrhage and GI bleeding
- Greater than 3 hours from injury
- Known sensitivity to TXA
- Previous DVT or Pulmonary Embolism
Total of 2 Grams
- Initial bolus of 1 Gm over 10 minutes (Slow IV push). Draw up with filter needle.
- Maintenance: additional 1 Gm over next 8 hours (mix in 50 mL of NS). Call Pharmacy to mix and deliver the continuous infusion.
- Initial bolus of 20mg/kg IV Bolus over 10 minutes
- Maintenance: 10 mL/kg/hr over next 8 hours
No additional laboratory tests required.
- Epistaxis: 500mg-1g IV applied to packing or pressure device, some practitioners mix 1:1 with NS in a basin
- Thrombotic events
- Hypotensionwith rapid injection
- Nausea, vomiting, diarrhea
- Impaired color vision and other visual disturbances
- CRASH-2 collaborators, Roberts I, Shakur H, Afolabi A, Brohi K, Coats T, Dewan Y, Gando S, Guyatt G, Hunt BJ, Morales C, Perel P, Prieto-Merino D, Woolley T. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011 Mar 26;377(9771):1096-101,