What is the dose of tranexamic acid used when bleeding after thrombolysis and blood products are contraindicated or ineffective?

• A. 500 mg IV over 5 minutes
• B. 2 g IV over 20 minutes
• C. 1000 mg IV over 10 minutes
• D. 5 g IV over 30 minutes

Answer: (C)

When bleeding occurs after thrombolysis and sending blood products isn’t an option, using tranexamic acid helps to stabilize clots by blocking the breakdown of fibrin. It inhibits the conversion of plasminogen to plasmin, slowing fibrinolysis and promoting hemostasis quickly.

The recommended dose is a one-time 1,000 mg administered intravenously over about 10 minutes. This rapid bolus provides prompt antifibrinolytic effect to control bleeding. Doses like 500 mg over 5 minutes would be subtherapeutic, while larger doses such as 2 g or 5 g over longer periods aren’t the standard for this scenario and carry greater risk. In some protocols, a second dose may be considered if bleeding continues, but the initial effective dose is 1 g IV over 10 minutes. Monitor for potential thrombotic events and adjust for renal function as needed.