Difference between revisions of "Tranexamic acid"

(Created page with "==Background== *Action: Antifibrinolytic agent *Availability: **Ampule of 1 Gm in 10 mL ==Indication== Severely bleeding trauma patient, systolic blood pressure of <90 and/or ...")
 
(See Also)
 
(23 intermediate revisions by 7 users not shown)
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==Background==
 
==Background==
 
*Action: Antifibrinolytic agent
 
*Action: Antifibrinolytic agent
*Availability:  
+
*Competitive inhibitor of plasminogen activation to plasmin
**Ampule of 1 Gm in 10 mL  
+
*Dosing Availability:  
 +
**Ampule of 1 Gm in 10 mL
 +
*Formulations: IV and PO; can use IV as topical
  
 
==Indication==
 
==Indication==
Severely bleeding trauma patient, systolic blood pressure of <90 and/or heart rate > 110 beats/min., with expected requirement for massive transfusion.
+
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_(main)|intracranial hemorrhage]] and [[Undifferentiated_upper_gastrointestinal_bleeding|GI bleeding]]
  
 
==Contraindication/Exclusion Criteria==
 
==Contraindication/Exclusion Criteria==
 
*Greater than 3 hours from injury
 
*Greater than 3 hours from injury
 
*Known sensitivity to TXA
 
*Known sensitivity to TXA
*Previous DVT or Pulmonary Embolism
+
*Previous [[DVT]] or Pulmonary Embolism
  
 
==Administration==
 
==Administration==
*Adult dose- Total of 2 Gms
+
===Adult dose===
**Initial bolus of 1 Gm over 10 minutes (Slow IV push). Draw up with filter needle.
+
''Total of 2 Grams''
**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 1 Gm over 10 minutes (Slow IV push). Draw up with filter needle.
*Pediatric dose- (weight based)
+
*Maintenance: additional 1 Gm over next 8 hours (mix in 50 mL of NS). Call Pharmacy to mix and deliver the continuous infusion.<ref>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,</ref>
**Initial bolus of 20 mg/kg IV Bolus over 10 minutes
+
===Pediatric dose===
**Maintenance: 10 mL/kg/hr over next 8 hours
+
''Weight based''
 +
*Initial bolus of 20mg/kg IV Bolus over 10 minutes
 +
*Maintenance: 10 mL/kg/hr over next 8 hours
  
No additional laboratory tests required.  
+
No additional laboratory tests required.
 +
 
 +
===Topical use===
 +
*Epistaxis: 500mg-1g IV applied to packing or pressure device, some practitioners mix 1:1 with NS in a basin
  
 
==Adverse Reactions==
 
==Adverse Reactions==
 
*Thrombotic events
 
*Thrombotic events
*Hypotension with rapid injection
+
*[[Hypotension]]with rapid injection
 
*Nausea, vomiting, diarrhea
 
*Nausea, vomiting, diarrhea
 
*Impaired color vision and other visual disturbances
 
*Impaired color vision and other visual disturbances
  
==Source==
+
==See Also==
Harbor-UCLA Tranexamic Acid (TXA) Guidelines for Administration in Trauma
+
*[[EBQ:MATTERs_Study|MATTERs Study]]
 +
*[[EBQ:CRASH-2_Trial|Crash-2 Trial]]
 +
*[[EBQ:CRASH-3 Trial|Crash-3 Trial]]
 +
*[[Halt it]] trial
 +
*[[Transfusions]]
 +
*[[Transfusion Reactions]]
 +
 
 +
==External Links==
 +
*[http://www.emcurious.com/blog-1/2014/7/11/bcej55h3s3rk93uekwtvw9biixn0y8 EMCurious - TXA Trauma Lit Review]
 +
*[http://www.emdocs.net/txa-use-trauma-update/ EMDocs TXA]
 +
 
 +
==References==
 +
<references/>
 +
 
 +
[[Category:Pharmacology]]
 +
[[Category:Trauma]]

Latest revision as of 12:53, 18 July 2020

Background

  • 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

Indication

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

Contraindication/Exclusion Criteria

  • Greater than 3 hours from injury
  • Known sensitivity to TXA
  • Previous DVT or Pulmonary Embolism

Administration

Adult dose

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.[1]

Pediatric dose

Weight based

  • Initial bolus of 20mg/kg IV Bolus over 10 minutes
  • Maintenance: 10 mL/kg/hr over next 8 hours

No additional laboratory tests required.

Topical use

  • Epistaxis: 500mg-1g IV applied to packing or pressure device, some practitioners mix 1:1 with NS in a basin

Adverse Reactions

  • Thrombotic events
  • Hypotensionwith rapid injection
  • Nausea, vomiting, diarrhea
  • Impaired color vision and other visual disturbances

See Also

External Links

References

  1. 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,