Difference between revisions of "Tranexamic acid"
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(→See Also) |
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*Dosing Availability: | *Dosing Availability: | ||
**Ampule of 1 Gm in 10 mL | **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== | ||
| Line 24: | Line 31: | ||
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== | ||
| Line 34: | Line 44: | ||
*[[EBQ:MATTERs_Study|MATTERs Study]] | *[[EBQ:MATTERs_Study|MATTERs Study]] | ||
*[[EBQ:CRASH-2_Trial|Crash-2 Trial]] | *[[EBQ:CRASH-2_Trial|Crash-2 Trial]] | ||
| + | *[[EBQ:CRASH-3 Trial|Crash-3 Trial]] | ||
| + | *[[Halt it]] trial | ||
*[[Transfusions]] | *[[Transfusions]] | ||
*[[Transfusion Reactions]] | *[[Transfusion Reactions]] | ||
| + | |||
==External Links== | ==External Links== | ||
*[http://www.emcurious.com/blog-1/2014/7/11/bcej55h3s3rk93uekwtvw9biixn0y8 EMCurious - TXA Trauma Lit Review] | *[http://www.emcurious.com/blog-1/2014/7/11/bcej55h3s3rk93uekwtvw9biixn0y8 EMCurious - TXA Trauma Lit Review] | ||
Latest revision as of 12:53, 18 July 2020
Contents
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
- ↑ 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,