Tranexamic Acid

Aliases: Cyklokapron 

Indications: Moderate to severe hemorrhage and/or for injury < 3 hours old, SBP < 90 mmHg with suspected hemorrhage, Pedi SBP < 70 + (age in yrs. x 2). Traumatic Brain Injury with GCS 3-12.          

Contraindications: Hypersensitivity to tranexamic acid or any of the ingredients, or active intravascular clotting.  

Concentrations: 

Injection: 100 mg/mL

Dosing

Max dosing not to be exceeded during a single encounter without discussion with Medical Control.

Adult:

Indication	Dose	Route	Note
-Moderate to Severe Traumatic Hemorrhage  -Traumatic Brain Injury with GCS 3-12  -Postpartum Hemorrhage	2 g	Slow IV Push	Give once
Dental/Nasal/Wound Hemorrhage	1 g	Topical	Soak gauze in TXA and pack into source of bleeding

Pediatric:

Indication	Dose	Route	Note
-Moderate to Severe Traumatic Hemorrhage  -Traumatic Brain Injury with GCS 3-12  -Postpartum Hemorrhage	40 mg/kg Max: 2 g	Slow IV Push	Give once
Dental/Nasal/Wound Hemorrhage	1 g	Topical	Soak gauze in TXA and pack into source of bleeding

Precautions:

Allergic dermatitis, giddiness, and hypotension have been reported occasionally. 

Hypotension has been observed when intravenous injection is too rapid. To avoid this response, the solution should not be injected rapidly. 

Use with caution in patients with history of thrombotic events or potentially having an active MI or PE. 

Adverse/Side Effects: Dizziness, nausea, vomiting, chest pain 

Class: Antifibrinolytic Agent 

Mechanism of Action: Tranexamic acid is a competitive inhibitor of plasminogen activation, and at much higher concentrations, a noncompetitive inhibitor of plasmin, i.e., actions like aminocaproic acid. Tranexamic acid is about 10 times more potent in vitro than aminocaproic acid. Tranexamic acid binds more strongly than aminocaproic acid to both the strong and weak receptor sites of the plasminogen molecule in a ratio corresponding to the difference in potency between the compounds. Tranexamic acid in a concentration of 1 mg per mL does not aggregate platelets in vitro.  

Onset of Action	Peak Effect	Duration of Action
5-15 minutes	Varies	~3 hours