Tranexamic acid

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
• Common Trade Names: Cyklokapron

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.

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

Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

Indication	Dose	Context	Route	Population
Angioedema	1 g IV over 10 min	Bradykinin-mediated angioedema (e.g., ACE-I induced)	IV	Adult
Epistaxis	500mg topically	Applied to foam or packing and inserted into nares	Topical (intranasal)	Adult
Intracranial hemorrhage (main)	1g IV (within 3 hrs of event), then 1g over 8 hrs	Coagulopathy reversal in ICH	IV	Adult
Postpartum hemorrhage	1 g over 10 min, repeat in 30 min if ongoing bleed	Antifibrinolytic	IV	Adult
Traumatic intracerebral hemorrhage	1g IV (within 3 hrs of event), then 1g over 8 hrs	Coagulopathy reversal in ICH	IV	Adult

See Also

• MATTERs Study
• Crash-2 Trial
• Crash-3 Trial
• Halt it trial
• WOMAN trial - https://rebelem.com/the-woman-trial-early-txa-in-post-partum-hemorrhage/
• Transfusions
• Transfusion Reactions

External Links

• EMCurious - TXA Trauma Lit Review
• EMDocs TXA