Tranexamic Acid

1. Introduction

Tranexamic acid (TXA) is an antifibrinolytic agent that works by inhibiting plasminogen activation, preventing the breakdown of blood clots. It is used to control excessive bleeding in various conditions, including menorrhagia, trauma, and surgery.

2. Indications

  • Menorrhagia (Heavy Menstrual Bleeding)
  • Surgical Bleeding Prevention:
    • Cardiac surgery
    • Orthopaedic surgery
    • Dental surgery (especially in patients with haemophilia)
  • Trauma-Related Bleeding (Major Haemorrhage)
  • Postpartum Haemorrhage (PPH)
  • Nosebleeds (Epistaxis)
  • Hereditary Angioedema (Off-Label Use)

3. Dosage

Adults:

  • Menorrhagia:
    • 1 g three times daily for up to 4–5 days during menstruation.
  • Surgical Bleeding Prevention:
    • 1 g before surgery, then 1 g every 6–8 hours for up to 24 hours postoperatively.
  • Trauma-Related Bleeding:
    • 1 g IV over 10 minutes, followed by 1 g IV over 8 hours.
  • Postpartum Haemorrhage (PPH):
    • 1 g IV over 10 minutes, may repeat after 30 minutes if bleeding persists.
  • Nosebleeds (Epistaxis):
    • 500 mg applied topically as a soaked gauze or oral 1 g three times daily for 5 days.

Paediatric Use:

  • Surgical Bleeding Prevention: 10 mg/kg IV before surgery, then every 6–8 hours as needed.

Elderly:

  • No dose adjustment required but monitor renal function.

Renal Impairment:

  • CrCl 30–50 mL/min: Reduce dose to 15 mg/kg twice daily.
  • CrCl 10–30 mL/min: Reduce dose to 15 mg/kg once daily.
  • CrCl <10 mL/min: Avoid use or use cautiously.

Hepatic Impairment:

  • No dose adjustment required.

4. Administration

  • Oral Tablets: Take with or without food.
  • IV Infusion: Administer slowly over 10 minutes to reduce the risk of hypotension.
  • Topical Use for Epistaxis: Apply soaked gauze directly into the nostril.

5. Forms Available

  • Tablets: 500 mg, 650 mg
  • IV Injection: 100 mg/mL (5 mL ampoules)
  • Oral Solution (some regions)

6. Side Effects

6.1 Common Side Effects:

  • Nausea
  • Vomiting
  • Diarrhoea
  • Muscle cramps

6.2 Less Common Side Effects:

  • Dizziness
  • Fatigue
  • Headache

6.3 Rare but Serious Side Effects:

  • Deep vein thrombosis (DVT)
  • Pulmonary embolism (PE)
  • Seizures (especially in high IV doses)
  • Hypotension (if given IV too rapidly)

7. Warnings

  • Increased Risk of Thrombosis: Avoid in patients with active thromboembolic disease (e.g., DVT, PE, stroke).
  • Seizure Risk: High doses or prolonged IV use can increase seizure risk.
  • IV Hypotension: Administer slowly to prevent a sudden drop in blood pressure.
  • Haematuria: Use with caution in urinary tract bleeding, as clots may cause obstruction.

8. Precautions

  • Monitor renal function in patients with kidney disease.
  • Caution in patients at risk of cardiovascular disease due to potential thrombotic risk.
  • Avoid concurrent use with hormonal contraceptives due to increased thrombotic risk.

9. Interactions

  • Oral Contraceptives (Oestrogen/Progestin): Increased risk of thrombosis.
  • Anticoagulants (e.g., warfarin, heparin): Opposing effects; avoid use together unless under strict medical supervision.
  • Fibrinolytic Agents (e.g., alteplase): TXA counteracts the effects of these drugs.

10. Monitoring Parameters

  • Bleeding Control: Assess effectiveness in reducing excessive bleeding.
  • Signs of Thrombosis: Monitor for leg pain, swelling, chest pain, or shortness of breath.
  • Renal Function: Particularly in elderly and renal impairment patients.

11. Use in Children

  • Safe in children for surgical bleeding prevention and epistaxis.
  • Doses based on weight (10 mg/kg IV or oral as needed).

12. Use in Pregnancy

  • Category B:
    • No evidence of fetal harm, but use only if benefits outweigh risks.
    • Commonly used in postpartum haemorrhage with good safety data.

13. Use in Elderly

  • Safe, but monitor renal function due to risk of accumulation.

14. Use in Kidney Disease

  • Dose reduction required in moderate to severe renal impairment.
  • Avoid in end-stage kidney disease (ESRD) unless benefits outweigh risks.

15. Use in Liver Disease

  • No specific dose adjustment required.

16. Patient Counselling Points

  • Take with or without food, but take with food if nausea occurs.
  • Report any signs of blood clots, such as leg pain, swelling, or chest pain.
  • Do not take with hormonal contraceptives unless advised by a doctor.
  • Stay hydrated to reduce muscle cramps and headaches.
  • For nosebleeds, use TXA-soaked gauze instead of swallowing tablets.

17. Table of Brand Names, Manufacturer, and Prices in USD

Brand NameManufacturerStrength/Dosage FormPrice (USD)
CyklokapronPfizer500 mg Tablet$50 (30 tablets)
LystedaFerring Pharmaceuticals650 mg Tablet$80 (30 tablets)
Generic TXAVarious500 mg Tablet$20 (30 tablets)
Cyklokapron IVPfizer100 mg/mL IV Injection$100 (10 vials)

18. 15 FAQs (Frequently Asked Questions)

1. What is Tranexamic Acid used for?
It is used to reduce excessive bleeding in menorrhagia, surgery, trauma, and postpartum haemorrhage.

2. How does Tranexamic Acid work?
It inhibits plasminogen activation, preventing the breakdown of clots.

3. How long does it take to work?
Effects start within 2–3 hours after oral administration.

4. Can Tranexamic Acid be taken daily?
No, it is only used when needed for bleeding episodes.

5. Can it be taken with ibuprofen or paracetamol?
Yes, it can be safely taken with painkillers for menstrual cramps.

6. Can Tranexamic Acid cause blood clots?
Yes, it may increase the risk of thrombosis, especially in high-risk patients.

7. Can it be used for haemophilia?
Yes, it is used in dental procedures in haemophilia patients.

8. Is Tranexamic Acid a blood thinner?
No, it prevents clot breakdown but does not thin the blood.

9. Can I use it for nosebleeds?
Yes, either orally or as a soaked gauze applied to the nostril.

10. Does Tranexamic Acid help with bruising?
Yes, it may reduce bruising but is not typically prescribed for this.

11. Can Tranexamic Acid be used long-term?
No, it is used short-term to control active bleeding episodes.

12. Can pregnant women take it?
Yes, it is used for postpartum haemorrhage but should be taken only if necessary.

13. Does it affect periods?
It reduces heavy menstrual bleeding, but does not affect the menstrual cycle itself.

14. Can I drink alcohol while taking it?
Yes, but avoid excessive alcohol, which may increase bleeding risk.

15. How should it be stored?
Store at room temperature, away from moisture and heat.