Tranexamic Acid (TXA)

Updated January 27, 2015
Author: McAllister

Description: Tranexamic Acid, an antifibrinolytic, is used off label to reduce bleeding in certain kinds of surgery, including major orthopedic and spine.


Introduction:

Tranexamic acid is a synthetic derivative of the amino acid lysine that exerts its antifibrinolytic effect through the reversible blockade of lysine binding sites on plasminogen molecules. Tranexamic acid is useful in a wide range of haemorrhagic conditions. The drug reduces postoperative blood losses and transfusion requirements in a number of types of surgery, with potential cost and tolerability advantages over aprotinin.


Dosing

ADULT: Prevention of perioperative bleeding associated with spinal surgery (eg, spinal fusion) (unlabeled use): 

I.V.: 2000 mg over 20 minutes prior to incision followed by 100 mg/hour during surgery and for 5 hours postoperatively (Elwatidy, 2008) or 10 mg/kg prior to incision followed by 1 mg/kg/hour for the remainder of the surgery; discontinue at time of wound closure (Wong, 2008)

 

PEDS: Prevention of perioperative bleeding associated with spinal surgery (eg, spinal fusion) (unlabeled use): Children and Adolescents:

I.V.: 10 mg/kg given over 15 minutes prior to incision followed by 1 mg/kg/hour for the remainder of the surgery; discontinue at time of wound closure (Neilipovitz, 2001; Verma, 2010)

or

100 mg/kg over 15 minutes prior to incision followed by 10 mg/kg/hour until skin closure (Sethna, 2005)

or

30 mg/kg over 20 minutes prior to incision followed by 1 mg/kg/hour during surgery and for 5 hours postoperatively (Elwatidy, 2008)


Pharmacokinetics

Pharmacokinetic data, tranexamic acid
34%
3.1 h

 


Adverse Effects

Rare. Generally, gastrointestinal effects, dizziness, fatigue, headache, and hypersensitivity reactions.

Use of tranexamic acid has a potential risk of thrombosis


References