ASK DIS: Indication for Topical Tranexamic acid

These lists are not exhaustive. Indications are listed based on the common use and applications in our practice at our setting
Topical application of tranexamic acid to bleeding wound surfaces reduces blood loss in patients undergoing some major surgeries, without systemic complications
topical application of tranexamic acid reduces bleeding and blood transfusion in surgical patients
In a Cochrane review of the topical use of TXA in intra-cardiac surgery, orthopedic surgery, epistaxis, and dental extractions, there were no adverse events reported regarding myocardial infarction, pulmonary embolism, stroke, or deep vein thrombosis

Total Hip or Knee Arthroplasty

There have been a number of mostly small trials, which have consistently shown at least a trend towards benefit of tranexamic acid (TXA) in both total knee arthroplasty (TKA) and total hip arthroplasty (THA) without an increased risk for thromboembolic complications
number of meta-analyses which have demonstrated reduced total blood loss by a mean of 500 ml in TKA and 300-400 ml in THA and a reduced need for transfusion of allogeneic blood by about 45% in TKA and nearly 30% in THA with TXA versus control
use of TXA in reducing blood loss and transfusion requirements during total knee or total hip replacement surgery is off-label despite evidence to support its use
Joint Irrigation Dose: 1.5-3 grams mixed in 50-100 mL saline applied topically to the cemented joint.
TXA should be left in place for at least 5 minutes
The remaining fluid is suctioned prior to wound closure D.
Intra-Articular Dose:
250 mg-2 grams mixed in 20, 50 or 100 mL saline and instilled into the joint drain
Drain should be clamped for 30-60 minutes

Melasma

Melasma is an acquired hypermelanosis of sun-exposed areas.
Results on effectiveness of topical tranexamic acid are not consistent, thus does not warrant its recommendations
Some studies showed topical tranexamic acid plus sunscreen was not more effective than vehicle plus sunscreen in decreasing facial pigmentation. However, topical TA produced erythema
However a recent 2014 study showed a significant reduction in Melasma Area and Severity Index (MASI) when topical solution of 3% Tranexamic acid, and topical solution of 3% hydroquinone + 0.01% dexamethasone was compared

Dental Procedures

largest body of evidence for use of topical TXA exists in the dental literature
As compared to treatment with IV factor transfusion followed by a placebo mouthwash (performed on the same cohort with two weeks separation), topical TXA was found to be non-inferior and an effective alternative to factor therapy in controlling gingival hemorrhage

Epistaxis

higher rate of rebleeding in the first 24 hours and within 1 week in the group treated with anterior nasal packing as compared to those treated with TXA.
Such interventions should be undertaken with caution in patients in whom the potential dangers of systemic thrombosis are high (eg, known coronary or cerebrovascular disease), as the systemic absorption of TXA through the nose is not well characterized.

Head and Neck Cancer Associated Bleeding

References:

http://www.pbm.va.gov/PBM/clinicalguidance/clinicalrecommendations/Tranexamic_Acid_in_TKA_or_THA_Clinical_Recommendations
Topical Application of Tranexamic Acid Reduces Postoperative Blood Loss in Total Knee Arthroplasty. http://jbjs.org/content/92/15/2503
Topical application of tranexamic acid for the reduction of bleeding. http://www.ncbi.nlm.nih.gov/pubmed/23881695
http://www.worldwidewounds.com/2002/march/Naylor/Symptom-Control-Fungating-Wounds.html
Melasma. http://emedicine.medscape.com/article/1068640-treatment.
Topical 5% tranexamic acid for the treatment of melasma in Asians: a double-blind randomized controlled clinical trial. http://www.ncbi.nlm.nih.gov/pubmed/22506692
WOUND MANAGEMENT GUIDELINES AND PRESSURE ULCER PREVENTION ACTION CARD. http://www.gloshospitals.nhs.uk/

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