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# Tranexamic Acid ## Overview Tranexamic acid is an antifibrinolytic agent that competitively inhibits the activation of plasminogen to plasmin, thereby reducing fibrinolysis. ## Primary Indications * Hemorrhagic conditions due to excessive fibrinolysis, including: * Menorrhagia * Gastrointestinal bleeding (e.g., from peptic ulcer disease, hereditary hemorrhagic telangiectasia) * Epistaxis * Postpartum hemorrhage (PPH) * Surgical or traumatic bleeding * Dental procedures in patients with bleeding disorders * Hereditary angioedema (prophylaxis and treatment) ## Adult Dosing Dosing varies significantly by indication and local protocol. * **Menorrhagia:** 1000 mg (e.g., 2 tablets of 500 mg or 10 mL of 100 mg/mL solution) orally three to four times daily during menstruation, not to exceed 4000 mg/day. Treatment typically lasts for up to 4 days per cycle. * **Hemorrhagic Conditions (General):** * **Oral:** 1000 mg to 1500 mg (e.g., 2-3 tablets of 500 mg or 10-15 mL of 100 mg/mL solution) three to four times daily. * **Intravenous (IV):** 500 mg to 1000 mg (e.g., 5-10 mL of 100 mg/mL solution) IV every 6 to 8 hours. * **Postpartum Hemorrhage (PPH):** 1000 mg (e.g., 10 mL of 100 mg/mL solution) IV as a single dose as soon as possible after birth if excessive bleeding occurs. If bleeding continues, a second dose of 1000 mg IV can be administered 30 minutes later. Additional doses may be given every 8 hours. (WHO recommends 1 gram IV within 3 hours of birth). * **Hereditary Angioedema (HAE):** * **Prophylaxis:** 1000 mg orally three times daily. * **Acute Attack Treatment:** 1000 mg orally three times daily until symptoms resolve. ## Pediatric Dosing Dosing in pediatrics is not well-established and should be guided by institutional protocols, patient weight, and clinical response. Some sources suggest: * **Oral:** 25 mg/kg/dose three to four times daily, not to exceed adult doses. * **IV:** 10 mg/kg/dose three to four times daily. ## Dose Adjustments * **Renal Impairment:** Dose adjustment is necessary based on creatinine clearance (CrCl). * CrCl 50-80 mL/min: 2000 mg/day orally or 1000 mg IV every 12 hours. * CrCl 10-50 mL/min: 1000 mg/day orally or 500 mg IV every 12 hours. * CrCl <10 mL/min: 500 mg/day orally or 500 mg IV every 24 hours. ## Contraindications * Active intravascular clotting (e.g., deep vein thrombosis, pulmonary embolism, arterial thrombosis). * Acquired defective color vision. * Subarachnoid hemorrhage (SAH). * Hypersensitivity to tranexamic acid. ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, dizziness, headache, abdominal discomfort. * **Serious:** Thrombotic events (deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke), allergic reactions, vision changes (especially with long-term use or high doses). ## Key Drug Interactions * **Hormonal contraceptives (oral, transdermal, vaginal rings, injections, implants):** Increased risk of thromboembolic events. Concomitant use is generally discouraged. * **Factor VIIa (recombinant):** Case reports suggest increased risk of thrombosis. * **Antifibrinolytics (e.g., aminocaproic acid):** Increased risk of thrombosis. Avoid concomitant use. ## Monitoring * **Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen levels:** May be monitored to assess coagulation status, especially in severe bleeding or thrombosis risk. * **Renal function:** Crucial for dose adjustment. * **Vision:** Regular ophthalmologic exams recommended for patients on long-term therapy or at high risk. * **Signs and symptoms of thrombosis:** Monitor for leg swelling, chest pain, shortness of breath, sudden numbness or weakness, sudden severe headache, or vision changes. ## Clinical Pearls * Tranexamic acid is most effective when administered early in the course of bleeding. * For IV administration, dilute in a compatible solution (e.g., 0.9% sodium chloride, 5% dextrose) and infuse slowly to minimize side effects. * Oral administration can be taken with or without food. * Consider tranexamic acid's renal excretion when dosing. * The risk of thrombosis appears to be dose- and duration-dependent. *** *This information is a summary and does not replace the need to consult the official prescribing information or a qualified healthcare professional. Always verify current drug information before prescribing or administering medication.*