202208112251
Status:
Tags: pharmacology
Tranexamic acid
- synthetic derivative of lysine
- blocks lysine binding sites of plasminogen molecules
- inhibit conversion of plasminogen to plasmin which degrades fibrin
- ADR
- thrombotic events
- post-op seizures
- Plasma T1/2 2h
Drug error - intrathecal TXA
Dose:
10-30mg/kg IV (max 2g)
15-25mg/kg PO Q8H
in the literature threshold ~4-8g (higher dose >4g)
Major trials
CRASH-2 used doses which are commonly used clinically; 1 g as an IV bolus followed by 1 g as an IV infusion over 8 hours. Other studies suggest using 2 g as a single bolus which may improve delivery of an effective dosage without increasing side effects.
POISE-3 trial was able to demonstrate ↓ bleeding in non-cardiac surgery when TXA was used over placebo.
However, it failed to meet the criteria to demonstrate TXA was non-inferior with regards to cardiac or thromboembolic events, with a small (0.3%) ↑ risk
CRASH-3 trial reported no increase in thrombotic complications in patients with traumatic brain injury who were given TXA
WOMAN trial also confirmed the safety of TXA. It demonstrated a reduction in death due to bleeding when TXA was administered to patients with a postpartum haemorrhage with no increased risk of thromboembolic events