TXA for Wounds

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Sean and Scott chat TXA for wounds from UC Grand Rounds October 2022. 

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janardan T. -

couple of comments
what is the cost of TXA
Do you start as soon as the patient comes into the department
What about pressure dressings
What happened giving epi with lidocaine

AJ -

Hilarious...the only thing missing was "order now and get TWO for just $19.99!" Nice.

Sean N. -

Hi Janardan,

Thank you for the comments and questions

The cost of tranexamic acid (TXA) injectable 1000 mg/10 mL is generally less than $10 and the TXA 650 mg tablets are approximately $5 per tablet in the United States.

Of course, each institution have different distributors and price could vary and these are acquisition cost (AWP) not billing costs

Your question is when to start for bleeding wounds?

I would recommend you use your standard approach for bleeding wounds and use TXA as an adjunct

I start with direct pressure and if large amount of blood or pulsatile (eg, arteriole in scalp laceration) try to find the source of bleeding for better control (eg, figure of 8 suture if needed or cautery)

Lidocaine with epinephrine is great too, particularly to allow for better visualization and pain relief

I agree with you, pressure dressings can be very effective as long as properly applied, and tourniquets if indicated (eg, large lacerations on extremities)

If cannot get hemostasis using multiple approaches, I would recommend TXA applied topically

Of course, you could apply at any time although as you are controlling bleeding there is usually a delay getting TXA immediately although should be readily available (eg, PYXIS)

The application of TXA can be with either the injection or make a slurry paste with crushing the tablets (eg, crush two tablets and put in 2-3 mL of 0.9% sodium chloride or sterile water) and apply. I generally use the solution as quicker and price is similar

For dental extractions, can use TXA as a mouthwash, either with the solution or crush the tablets and dilute with more volume rather than a paste

Thanks for what you do!


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