Tranexamic Acid (TXA)
GENERIC NAME
Tranexamic Acid (TXA)
TRADE NAME
Cyclokapron, Lysteda
DESCRIPTION
Tranexamic Acid (TXA) is an antifibrinolytic agent that helps promote clot formation by preventing the breakdown of fibrin clots. It is used in cases of massive hemorrhage, particularly in trauma and postpartum hemorrhage, to reduce bleeding and improve patient outcomes.
HOW SUPPLIED
1 gram in 10 ml vial
PREPARATION
Mix 1 gram of TXA in 100 ml of Normal Saline (NS).
INDICATIONS
- Hemorrhagic shock or cardiac arrest due to trauma less than three hours old
- Suspected need for massive blood transfusion due to significant internal or external bleeding, indicated by sustained heart rate ≥ 110/min and SBP < 90 mmHg
- Blood loss greater than 500 ml with continued bleeding in a postpartum situation
CONTRAINDICATIONS
- Non-hemorrhagic shock
- Non-traumatic hemorrhagic shock
- Hemorrhagic shock stabilized with other hemostatic agents or measures
- Isolated traumatic brain injury
MECHANISM OF ACTION
Tranexamic Acid inhibits the activation of plasminogen to plasmin, preventing the breakdown of fibrin clots (antifibrinolytic action). This helps stabilize formed clots and reduce ongoing bleeding.
SPECIAL CONSIDERATIONS
- Obtain two blood pressure and heart rate measurements to confirm sustained HR ≥ 110/min and SBP < 90 mmHg before administering TXA to patients likely to respond to fluid bolus(es). Do not delay TXA administration for patients with obvious signs of hemorrhagic shock.
- Prepare the solution just prior to administration. Discard if not used immediately.
- Although there is a theoretical concern, current evidence does not show a significant increase in deep venous thrombosis, pulmonary embolism, myocardial infarction, or stroke with TXA use in published trials.
SIDE EFFECTS
- None known at this time
AUTHORIZATION
Paramedic: Standing order and Medical Control
DOSAGE
| Patient Type | Route | Dosage | Maximum Dosage |
|---|---|---|---|
| Adult (≥ 12 years) | IV infusion | 1 gram IV over 10 minutes; mix 1 gram in 100 ml NS | 1 gram total dose |
| Pediatric | IV/IO infusion | 15 mg/kg IV/IO over 10 minutes; mix 15 mg/kg in 100 ml NS | Consult Medical Control for specific maximum dose |
Administration Notes:
- Infuse TXA over 10 minutes. For adult administration, use a 60 gtts tubing for a straight IV stream or a 10 gtts tubing at 100 drops/minute.
- Monitor the patient’s vital signs and hemodynamic status closely during and after infusion.
- Do not delay administration in patients with clear signs of hemorrhagic shock, as early administration improves outcomes.