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# Tranexamic Acid
## Overview
Tranexamic acid is an antifibrinolytic agent that competitively inhibits the activation of plasminogen to plasmin, thereby preventing fibrinolysis.
## Primary Indications
* Hemorrhagic complications associated with hyperfibrinolysis, including excessive menstrual bleeding, epistaxis, hematuria, and gastrointestinal bleeding.
* Prophylaxis and treatment of bleeding associated with certain surgical procedures (e.g., cardiac, orthopedic, prostatectomy).
* Management of hereditary angioedema.
## Adult Dosing
* **Hemorrhagic Complications:** 1 to 1.5 grams (1000-1500 mg) orally 3-4 times daily. For severe bleeding, intravenous administration may be used: 50 mg/kg (up to 4 grams) per dose, not to exceed 200 mg/kg/day. Dosing and frequency depend on severity and may be guided by local protocol.
* **Surgical Prophylaxis:** Typically 1 gram (1000 mg) IV given within 15 minutes before incision, followed by 1 gram (1000 mg) IV every 8 hours for up to 24 hours, or as per surgical protocol.
* **Hereditary Angioedema:** 1 gram (1000 mg) orally 2-3 times daily.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should generally be guided by expert advice or specific protocols. Published data suggests IV doses of 10-25 mg/kg per dose, every 8-12 hours, for bleeding. For oral administration, studies have used doses similar to adult recommendations based on body weight (e.g., 25 mg/kg/day divided every 8-12 hours).
## Dose Adjustments
* **Renal Impairment:** Dose reduction is necessary based on creatinine clearance (CrCl).
* CrCl 50-80 mL/min: Give usual initial dose, then half the usual initial dose every 12 hours.
* CrCl 10-50 mL/min: Give usual initial dose, then one-third the usual initial dose every 24 hours.
* CrCl <10 mL/min: Give usual initial dose, then one-sixth the usual initial dose every 24 hours.
## Contraindications
* Active intravascular clotting or thrombus formation.
* Acquired defects in color vision.
* Hypersensitivity to tranexamic acid.
* Subarachnoid hemorrhage (may increase risk of vasospasm and infarction).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, dizziness.
* **Serious:** Thrombotic events (deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke), allergic reactions, visual disturbances (especially with prolonged use or high doses), hypotension (with rapid IV infusion).
## Key Drug Interactions
* **Hormonal contraceptives, estrogen-containing products:** Increased risk of thrombosis.
* **Factor VIIa concentrates:** Theoretical risk of excessive thrombosis.
* **Antihypertensives:** May potentiate hypotension with rapid IV administration.
* **Sympathomimetics (e.g., ephedrine):** May potentiate hypertensive effects.
## Monitoring
* Monitor for signs and symptoms of thromboembolic events (e.g., pain, swelling in extremities, chest pain, shortness of breath, neurological changes).
* Assess for visual changes, especially with long-term therapy.
* Monitor renal function for appropriate dose adjustments.
* Monitor bleeding status and response to treatment.
## Clinical Pearls
* Tranexamic acid is renally excreted; dose adjustments are crucial for patients with impaired renal function.
* Rapid intravenous infusion can cause hypotension. Administer slowly, typically over 5-10 minutes.
* While generally effective for bleeding due to hyperfibrinolysis, it is **contraindicated** in active intravascular clotting.
* Long-term oral use requires ophthalmologic monitoring due to potential for visual disturbances.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines before making treatment decisions.*
