Tranexamic acid

Revision as of 18:01, 10 July 2020 by Nate488 (talk | contribs) (Indication)

Background

  • Action: Antifibrinolytic agent
  • Competitive inhibitor of plasminogen activation to plasmin
  • Dosing Availability:
    • Ampule of 1 Gm in 10 mL

Indication

FDA-approved only for postpartum bleeding and periprocedural hemorrhage in hemophiliacs. IV and PO formulations, can use IV as topical 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,