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.
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)
100 mg/kg over 15 minutes prior to incision followed by 10 mg/kg/hour until skin closure (Sethna, 2005)
30 mg/kg over 20 minutes prior to incision followed by 1 mg/kg/hour during surgery and for 5 hours postoperatively (Elwatidy, 2008)
Pharmacokinetic data, tranexamic acid
Rare. Generally, gastrointestinal effects, dizziness, fatigue, headache, and hypersensitivity reactions.
Use of tranexamic acid has a potential risk of thrombosis
- Up-to-Date: Tranexamic Acid 2015 Drug Summary
- Wong J, El Beheiry H, Rampersaud YR, et al, “Tranexamic Acid Reduces Perioperative Blood Loss in Adult Patients Having Spinal Fusion Surgery,” Anesth Analg, 2008, 107(5):1479-86.
- Neilipovitz DT, Murto K, Hall L, et al, “A Randomized Trial of Tranexamic Acid to Reduce Blood Transfusion for Scoliosis Surgery,” Anesth Analg, 2001, 93(1):82-7.
- Verma K, Errico TJ, Vaz KM, et al, “A prospective, Randomized, Double-Blinded Single-Site Control Study Comparing Blood Loss Prevention of Tranexamic Acid (TXA) to Epsilon Aminocaproic Acid (EACA) for Corrective Spinal Surgery,” BMC Surg, 2010, 10:13.
- Sethna NF, Zurakowski D, Brustowicz RM, et al, “Tranexamic Acid Reduces Intraoperative Blood Loss in Pediatric Patients Undergoing Scoliosis Surgery,” Anesthesiology, 2005, 102(4):727-32.
- Elwatidy S, Jamjoom Z, Elgamal E, et al, “Efficacy and Safety of Prophylactic Large Dose of Tranexamic Acid in Spine Surgery: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study,” Spine, 2008, 33(24):2577-80.