Canterbury DHB

Tranexamic Acid

Anti-fibrinolytic treatment.

This is a synthetic derivative of the aminoacid lysine. Tranexamic acid, 4 -(aminomethyl) cyclohexanecarboxylic acid has antifibrinolytic activity in humans by binding reversibly to plasminogen, therefore blocking the binding of plasminogen to fibrin and its consequent activation to plasmin. Tranexamic acid is approximately 10 times more potent than aminocaproic acid (Amicar). This agent is effective even when bleeding is not associated with laboratory evidence of accelerated fibrinolysis. Mechanism of action thought to be inhibition of tissue fibrinolysis and consequent stabilisation of clots.

Adult doses: 1 g six to eight-hourly oral for 5 to 14 days.

Uses

• Primary menorrhagia

  Recommended when organic uterine lesions have been excluded and when combined hormonal preparations are either unacceptable, contraindicated or ineffective. Oral tranexamic acid, 10 to 15 mg per kilogram body weight, is usually 1 g eight-hourly, from the onset of menstrual bleeding until bleeding stops. Anticipated 40 to 50% reduction in blood loss.

• Oral bleeding in congenital and acquired coagulation disorders

  The oral mucosa and saliva are rich in plasminogen activators.

  Tranexamic acid mouth rinse. Use 10 mL (500/5 mL) orally six-hourly, and hold in mouth for minimum of five minutes. This is effective in the prevention of oral bleeding in patients with haemophilia, and in patients who require dental extraction while on long term oral anticoagulant therapy.

  This mouth rinse has a short expiry, approximately one week, and must be made up immediately before use.

• Bleeding in patients with thrombocytopenia

  Tranexamic acid is useful in reducing or controlling mucosal bleeding and bleeding with dental extraction in patients with low platelet counts without affecting the platelet count.

• Reducing blood loss during cardiac surgery

  Tranexamic consistently reduces blood loss by 30 to 40% when compared with placebo in patients undergoing cardiac surgery. Tranexamic acid dose 10 mg per kilogram given intravenously pre-operatively followed by 1 mg per kilogram per hour peri-operatively.

Side Effects

Dose-dependent side effects are predominantly gastrointestinal tract including nausea, vomiting, abdominal pain and diarrhoea. Theoretical risk of thrombotic side effects.

Caution in liver disease.

See the tranexamic acid Data Sheets on Medsafe.

Topic Code: 5306