UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: TXA Quick Review (submitted by Kortney Morrell, PharmD)

Keywords: bleeding, epistaxis, tranexamic acid (PubMed Search)

Posted: 3/2/2019 by Ashley Martinelli (Updated: 7/16/2019)
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Mechanism of Action 

Tranexamic Acid (TXA) is an antifibrinolytic agent that is a competitive inhibitor of plasminogen activation, and a non-competitive inhibitor of plasmin 

Inhibits the breakdown of fibrin mesh allowing clot formation

  • Vial Concentration: 1000mg/10 mL 

When is it Indicated? 

Epistaxis/Oral Bleeds/Fistula Bleeds

  • Local application of injectable form of TXA 
  • Dose: Gauze soaked with 500 mg (5 mL) applied topically to the site of bleeding 

Trauma

  • Criteria for use: Significant hemorrhage or significant risk of hemorrhage in adult trauma patients (SBP <90 mmHg and/or HR >110 bpm) 
  • Dose: 1g in 100 mL 0.9% NaCl infused over 10 minutes followed by 1g in 100 mL 0.9% NaCl over 8 hours 

Adverse Reactions 

  • Generally well tolerated
  • GI Disturbances: nausea, vomiting, diarrhea 
  • Thrombotic Events 
  • Hypersensitivity reactions: anaphylaxis and anaphylactoid reactions 
  • Hypotension following rapid injection (maximum rate is 100 mg/minute)