Tranexamic Acid (TXA)
Trauma hemorrhage, Postpartum hemorrhage, GI bleeding (controversial), Epistaxis
Indications
- Trauma hemorrhage
- Postpartum hemorrhage
- GI bleeding (controversial)
- Epistaxis
Adult dosing
- trauma: dose: 1; unit: g IV over 10 min then 1g over 8h; route: IV; fixed: true; postpartum: dose: 1; unit: g IV over 10 min; route: IV; fixed: true; epistaxis: dose: 500; unit: mg in 5mL soaked gauze topical; route: Topical; fixed: true
Pediatric dosing
- trauma: dose: 15; unit: mg/kg; maxDose: 1000; maxDoseAbsolute: true; route: IV; weightBased: true
Contraindications
- Active thromboembolic disease
- History of seizures (relative)
Clinical pearls
- CRASH-2: give within 3 hours of injury — no benefit after 3 hours
- WOMAN trial: reduces death from postpartum hemorrhage
- HALT-IT: no benefit in GI bleeding — not recommended
- Topical TXA effective for epistaxis (NoPAC trial)
Source and review
- CRASH-2 (Lancet 2010); WOMAN trial (Lancet 2017). Last reviewed: 2024-11-01