Hemostatic Agents: Ácido Tranexámico and Vitamina K

Mechanisms of Action and Clinical Use

The European Association for the Study of the Liver recommends against the routine use of ácido tranexámico to decrease bleeding related to procedures in patients with cirrhosis, as a multicenter trial showed a higher risk of venous thromboembolic events in cirrhotic patients who received TXA 1
The American Association for the Study of Liver Diseases recommends correction of elevated INR using vitamina K, not fresh frozen plasma, in patients with cirrhosis 4
Ácido tranexámico inhibits fibrinolysis by binding to lysine binding sites on plasminogen molecules, thereby preventing the interaction of plasminogen with formed plasmin and fibrin, with approximately 90% excreted in urine within 24 hours 1
Vitamina K acts as an essential cofactor for the hepatic synthesis of vitamina K-dependent coagulation factors (factors II, VII, IX, X) and anticoagulant proteins (protein C and S), correcting deficiencies caused by vitamina K antagonists, liver disease, or nutritional deficiency 4
The timing of ácido tranexámico administration is critical, with ideal administration within the first 3 hours of bleeding onset for maximum efficacy 3

Ácido tranexámico is contraindicated in active disseminated intravascular coagulation and should be used with caution in massive hematuria and renal insufficiency, requiring dose adjustment 1, 3
High doses of ácido tranexámico are associated with an increased risk of seizures, especially in patients with renal dysfunction 1, 5

The typical dosage of ácido tranexámico for vascular surgery in anticoagulated patients is a loading dose of 10 mg/kg followed by an infusion of 1-5 mg/kg per hour 2
For severe bleeding, ácido tranexámico can be administered as 1g IV in 10 minutes, followed by 1g IV in 8 hours 3