Injection trenxamic acid dose
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tranexamic acid injection dose indications 2024
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Here is a complete dosing reference for Injection Tranexamic Acid (TXA):
Injection Tranexamic Acid - Dosing Reference
Available Formulation
- 100 mg/mL solution (standard ampoule: 500 mg/5 mL or 1000 mg/10 mL)
Dosing by Indication
| Indication | Dose | Frequency | Route |
|---|---|---|---|
| Local fibrinolysis (e.g. dental, ENT, urological) | 0.5-1 g (5-10 mg/kg) | 2-3 times daily | Slow IV |
| General/systemic fibrinolysis | 1 g (15 mg/kg) | Every 6-8 hours | Slow IV |
| Trauma hemorrhage (CRASH-2 protocol) | 1 g over 10 min, then 1 g over 8 hours | Single course | IV |
| Post-partum hemorrhage | 1 g IV over 10 min; repeat 1 g if bleeding continues after 30 min | Max 2 doses | IV |
| Surgical bleeding (elective) | 10-15 mg/kg before surgery | Can repeat every 6-8 hr | IV |
| Hemophilia - dental extraction | 10 mg/kg before procedure, then 10 mg/kg 3-4 times daily for 2-8 days | Short-term | IV |
Administration Rate (Critical)
- IV injection (undiluted): No faster than 1 mL/minute (= 100 mg/min) - rapid injection causes hypotension
- IV infusion (diluted): Dilute in NS 0.9% or D5W; infuse over at least 8 hours for maintenance
Renal Dose Adjustment
| GFR (mL/min/1.73m²) | Dose | Frequency |
|---|---|---|
| 20-50 | 10 mg/kg | Every 12 hours |
| 10-20 | 10 mg/kg | Every 24 hours |
| < 10 | 5 mg/kg | Every 24 hours |
Mechanism
TXA is an antifibrinolytic - it competitively inhibits plasminogen activation, preventing clot breakdown. It does NOT promote clotting directly.
Key Contraindications
- Active thromboembolic disease (DVT, PE, arterial thrombosis)
- History of convulsions / seizure disorder (high doses lower seizure threshold)
- Intrathecal, epidural, intraventricular, or intracerebral injection (risk of fatal cerebral edema and seizures)
- Acquired defective color vision
CRASH-2 Protocol (Trauma) - Most Widely Used
Based on the landmark CRASH-2 trial, for adults with trauma hemorrhage:
- Loading dose: 1 g IV over 10 minutes (within 3 hours of injury - critically, benefit is lost if given after 3 hours)
- Maintenance: 1 g IV over 8 hours
Common Side Effects
- Nausea, vomiting, diarrhea (most common)
- Hypotension (if injected too fast)
- Thromboembolism (use with caution in high-risk patients)
- Seizures (dose-dependent, especially at high doses)
Note: TXA should be given within 3 hours of injury/hemorrhage onset for maximum benefit - efficacy drops significantly after this window, and giving it after 3 hours in trauma may actually increase mortality.
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