Page 176 - 2026 SMOG

TRANEXAMIC ACID (CYKLOKAPRON/LYSTEDA)
Class/Mechanism of Action
• Antifibrinolytic Agent, Hemostatic Agent
Displaces plasminogen from fibrin, resulting in inhibition of fibrinolysis, and inhibits the proteolytic
activity of plasmin.
Indications
• Off-Label Indications
˚ Trauma-associated hemorrhage: casualty likely needing blood transfusion (hemorrhagic shock,
elevated lactate, one or more major amputations, penetrating torso trauma, or evidence of severe
bleeding)
˚ Postpartum hemorrhage (continued bleeding despite Oxytocin and fundal massage)
˚ Post-operative hemorrhage by dissection, enteric staples, or suspected internal bleeding
˚ Signs or symptoms of moderate or severe TBI or altered mental status associated with trauma
Contraindications
• TXA is contraindicated in trauma if the dose is not given within the first 3 hours following the
traumatic event (ideal dosing timeframe is as soon as possible)
• Hypersensitivity to tranexamic acid or any component of the formulation
• Non-traumatic subarachnoid hemorrhage
• Thromboembolic disease (Cerebral Thrombosis, DVT, PE)
Adverse Reactions/Precautions
• Disseminated intravascular coagulation (DIC): Use with extreme caution in patients with DIC
requiring antifibrinolytic therapy; patients should be under the strict supervision of a physician
experienced in treating this disorder. TXA should be used in patients with trauma-related DIC
• Thrombosis (especially when given after 3 hours from injury)
• Seizures have been reported; myoclonus is noted in 20% of patients after administration
• Visual defects have been reported: vision color change, impairment, loss, retinal artery, and venous
occlusion
• Pregnancy: Category B
• Lactation: Use caution
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Trauma-Associated Hemorrhage/Severe TBI Trauma-Associated Hemorrhage
(Off-Label use) (Off-Label use)
• IV/IO • IV/IO
˚ Initial: 2g in 100mL NS or LR bolus over ˚ Loading dose: 15mg/kg over 10min (max
dose: 1g), followed by 2mg/kg/hr for 8hr
10min, or 2g IV/IO push (given over 10min),
<3hr from time of injury (max dose: 1g)
Suspected Post-Operative Hemorrhage by
Dissection, Enteric Staples, or Suspected
Internal Bleeding
• IV/IO
˚ 2g in 100mL NS or LR bolus over 10min,
or 2g IV/IO push (given over 10min), <3hr
from time of injury

168 • MEDICATIONS