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Antifibrinolytic Agent

Tranexamic Acid 1g IV

Brand names: Cyklokapron, Cyclo-F

Adult dose

Dose: 1g IV over 10 minutes at induction, then 1g over 8 hours post-operatively. Topical: 1.5–3g in 50–100mL saline intra-articularly at wound closure.
Route: Intravenous or topical intra-articular
Frequency: Two doses IV (induction + 3h post-op) or single topical dose
Max: 3g/day IV (perioperative)
CRASH-2 protocol for major trauma: 1g IV over 10 min within 3h of injury, then 1g over 8h. Arthroplasty: IV or topical routes both effective (TRANX trials). Combined IV + topical may give greatest blood conservation.

Paediatric dose

Dose: 15 mg/kg
Route: IV
Frequency: Single dose at induction; repeat at 8h if needed
Max: 1g per dose
Concentration: 100 mg/mL mg/ml
Paediatric scoliosis and major orthopaedic surgery: 15–20 mg/kg IV at induction. Specialist use.

Dose adjustments

Renal

Reduce dose in renal impairment: eGFR 20–50: 10 mg/kg BD; eGFR 10–20: 10 mg/kg OD; eGFR <10: 5 mg/kg OD or 10 mg/kg every 48h

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Paediatric scoliosis and major orthopaedic surgery: 15–20 mg/kg IV at induction. Specialist use.

Clinical pearls

  • CRASH-2 trial: TXA within 3h of major trauma reduces all-cause mortality (RR 0.91) and haemorrhagic death (RR 0.85) — time-critical, give early
  • Arthroplasty: meta-analyses show TXA reduces blood transfusion rates by ~50% in THR and TKR with no increase in DVT/PE (NICE recommendation)
  • Topical TXA: avoids systemic absorption concerns — effective and safe in primary arthroplasty
  • WOMAN trial: TXA reduces maternal death from PPH — now WHO essential medicine
  • Never give intrathecally — causes severe refractory seizures

Contraindications

  • Active thromboembolic disease (DVT, PE, stroke)
  • History of convulsions (high-dose IV — proconvulsant)
  • Subarachnoid haemorrhage (may cause cerebral ischaemia)
  • Haematuria from upper urinary tract (risk of ureteral obstruction by clot)

Side effects

  • Nausea and vomiting (IV)
  • Diarrhoea
  • Dizziness
  • Hypotension (rapid IV infusion)
  • Seizures (high doses — especially intrathecal route, which is absolutely contraindicated)
  • Thromboembolic events (theoretical — not demonstrated in arthroplasty trials)

Interactions

  • Combined oral contraceptives — increased thrombotic risk
  • Clotting factor concentrates (Factor IX) — theoretical thrombosis risk

Monitoring

  • Blood loss (surgical drains, haemoglobin post-op)
  • Signs of DVT/PE post-operatively
  • Renal function (dose adjustment)

Reference: BNFc; BNF; CRASH-2 Trial (Lancet 2010); NICE NG24 (Major Trauma); NICE TA392 (Arthroplasty). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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