Administer tranexamic acid (TXA) intravenously within 3 hours of injury for patients with significant trauma-related bleeding, specifically those undergoing orthopedic surgery or sustaining significant orthopedic injuries.
Dosage and Administration
The typical dose is 1 gram intravenously as a bolus, followed by an infusion of 1 gram over 8 hours. Adjust dosage based on patient weight and renal function. Closely monitor for side effects, including thromboembolic events. Consider alternative treatments if contraindications exist.
Specific Orthopedic Applications
TXA shows benefit in reducing blood loss during total knee arthroplasty (TKA) and total hip arthroplasty (THA). It’s also used to manage bleeding in revision surgeries and other complex orthopedic procedures with high risk of significant blood loss.
Contraindications and Precautions
| Active thromboembolic disease | Avoid TXA; consider alternative haemostatic agents. |
| Severe renal impairment | Reduce dosage; carefully monitor serum creatinine levels. |
| History of seizures | Use with caution; monitor for neurological side effects. |
| Pregnancy | Weigh benefits against potential risks; consider alternatives. |
Monitoring and Adverse Effects
Monitor for signs of thromboembolism (e. g., deep vein thrombosis, pulmonary embolism), seizures, and allergic reactions. Regularly assess vital signs and urine output. Promptly address any adverse effects.
Post-Operative Management
Continue monitoring for bleeding and thromboembolic events post-operatively. Adjust pain management as needed. Patient education regarding early mobilization and prevention of venous thromboembolism is crucial.
Further Research
Ongoing research explores the optimal dosage and timing of TXA administration in various orthopedic procedures. Clinical trials are assessing its efficacy in specific patient subpopulations and in conjunction with other haemostatic methods.
