Tranexamic Acid for Minor Bleeding

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Introduction

Tranexamic acid (TXA) is a synthetic lysine derivative that inhibits fibrinolysis by blocking the lysine

binding sites on plasminogen. Plasminogen is an inactive form of plasmin which acts to dissolve fibrin

clots.

Clinical Detail

Properties

Tranexamic Acid (TXA)

Dose

Epistaxis: 500-1000 mg via topical nasal gauze

Heavy Menstrual Bleeding: 1.3 g PO TID

Hemoptysis: 500 mg via nebulizer

Formulation

IV 1000 mg/ 10 ml vial

650 mg tablets

PK/PD

Onset IV: 1-5 hours

Time to Peak Concentration PO: 2.5-3 hours; IV: 5 minutes

Duration PO: 24 hours; IV: 17 hours

Excretion: Urine (>95% as unchanged drug)

Adverse Effects

Rapid administration could cause hypotension

Drug Interactions

and Warnings

Caution in women taking oral contraceptives, patients with clotting disorders, and

those taking chlorpromazine

Compatibility

Compatible with Normal Saline and Dextrose solutions

Location in GHS

IV: Trauma Pyxis, Zone 2, Zone 3, CPR 2 + 3

Tablet: ED Chest Pyxis

Directions for Administration by Indication

Anterior Epistaxis

Consider using 500-1,000 mg of TXA (5-10 ml) to soak gauze/pledget and

insert it into the nasal cavity for ~30 min

Heavy Menstrual Bleeding

Consider administering 1300 mg of oral TXA tablets TID x 7 days

Evidence

Author, year

Indication

Intervention & Comparison

Outcome

Bryant-Smith

(Cochrane),

2018

Heavy

menstrual

bleeding

TXA*

TXA associated with a reduced blood loss of –

20 to – 73 ml per cycle and increased likelihood of

improvement

Effective for treating HMB compared to

placebo, NSAIDs, oral luteal progestogens

Lukes, 2010

Heavy

menstrual

bleeding

TXA 1300 mg PO TID x 7 days

TXA had greater decreased in menstrual blood loss, decreased

menstrual blood loss exceeding 50 mL, and increased

QOL compared with women receiving

placebo

Zirk, 2018

Dental

Bleeding

TXA soaked gauze*

TXA provided increased chance to stop oral bleeding

event by a factor of 1.6 over gauze alone

Nuvvula,

2014

Dental

Bleeding

Dissolved 500 mg TXA tablets

in 10 mL distilled water

Topical TXA was non-inferior and an effective

alternative to factor therapy in controlling

gingival hemorrhage.

Zahed, 2018

Conclusions

Zahed R et al. A New and Rapid Method for Epistaxis Treatment Using Injectable arm of Tranexamic Acid Topically: A Randomized

Controlled Trial Am J Emerg Med 2013. PMID: 23911102

Zahed R et al. Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet

Drugs: Randomized Controlled Trial. Acad Emerg Med. 2018 Mar;25(3):261-266. PMID: 29125679

Wand O et al. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. CHEST 2018. PMID: 30321510

Solomonov A et al. Pulmonary hemorrhage: A novel mode of therapy. Respir Med. 2009 Aug;103(8):1196-200.

How To Place An Epistaxis TXA Pack. https://www.youtube.com/watch?v=ekGsM9CZSpY

References

Tranexamic acid. Micromedex [Electronic version].Greenwood Village, CO: Truven Health Analytics. Retrieved September 6, 2018, from

http://www.micromedexsolutions.com/

Bryant-Smith AC et al. Antifibrinolytics for heavy menstrual bleeding. Cochrane Database Syst Rev. 2018 Apr 15;4. PMID: 29656433.

Lukes AS et al. Tranexamic acid treatment for heavy menstrual bleeding: a randomized controlled trial. Obstet Gynecol. 2010

Oct;116(4):865-75. PMID: 20859150

Zirk M et al. Supportive topical tranexamic acid application for hemostasis in oral bleeding events – Retrospective cohort study of 542

patients. J Craniomaxillofac Surg. 2018 Jun;46(6):932-936. PMID: 29627368

Nuvvula S et al. Efficacy of tranexamic acid mouthwash as an alternative for factor replacement in gingival bleeding during dental scaling

in cases of hemophilia: A randomized clinical trial. Contemp Clin Dent. 2014 Jan-Mar; 5(1): 49-53. PMID: 24808695