Tranexamic Acid*

• Tranexamic Acid

• TXA, Cyklokapron

Classification:

• Anti-fibrinolytic

Mechanism of Action:

• Competitively inhibits activation of plasminogen (via binding to the kringle domain), thereby reducing conversion of plasminogen to plasmin (fibrinolysin), an enzyme that degrades fibrin clots, fibrinogen, and other plasma proteins, including the procoagulant factors V and VIII.
• Tranexamic acid also directly inhibits plasmin activity, but higher doses are required than are needed to reduce plasmin formation.
  

Indications:

• Trauma with all of the following:
  • Less than 3 hours since the time of injury
  • Systolic BP < 90 mmHg or HR > 110
  • Suspicion of any hemorrhagic blood loss
• Hemorrhagic shock with lack of response to crystalloid therapy
• Primary post-partum hemorrhage unresponsive to oxytocin

Contraindications:

• Hypersensitivity
• Active thromboembolic disease (PE, DVT, CVA)
• Hematuria
• Unable to initiate bolus within 3 hours of injury
  

Precautions:

• In patients < 16 y/o
• Increase mortality if given more than 3 hours after initial trauma
• Appropriate fluid resuscitation should occur in conjunction with TXA administration
• Ensure transfusion continues after transfer of care

Adverse Effects:

• Nausea and vomiting
• Diarrhea
• Dizziness
• Changes in vision 

Dose:

Adult:

• 1 g mixed in 100 ml NS over 10 min IV/IO followed by 1 g mixed in 500 ml NS @ 60 ml/hr with buretrol or pump (for 8 hours)

Pediatric:

• Not routinely administered in pediatric patients

• IV, IO

• Fluid resuscitation to target permissive hypotension (SBP of 90 mmHg) should occur in conjunction with TXA administration
• It is important to ensure that ongoing infusion is maintained after transfer of care
• There is insufficient evidence to support the administration of TXA for lower gastrointestinal hemorrhage
• Pregnancy category B [if there is a clinical need for it, Category B drugs are considered safe to use]

• Compendium of Pharmaceuticals and Specialties (CPS)
• Pharmacology for the Prehospital Professional 2nd Edition