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# Tranexamic Acid ## Overview Tranexamic acid is an antifibrinolytic agent that competitively inhibits the activation of plasminogen to plasmin. Plasmin is a key enzyme responsible for fibrinolysis, thus tranexamic acid reduces the breakdown of blood clots. ## Primary Indications * Treatment and prevention of bleeding associated with hyperfibrinolysis. * Hemorrhagic cystitis. * Epistaxis. * Menorrhagia. * Management of bleeding in patients with hemophilia undergoing dental procedures. * Prevention of post-operative bleeding following certain surgeries (e.g., prostatectomy, cardiac surgery). * Management of traumatic bleeding. ## Adult Dosing * **General Antifibrinolytic:** 1 g IV every 6-8 hours. Oral alternative: 1-1.5 g orally three to four times daily. * **Menorrhagia:** 1 g orally up to three times daily for up to 4 days during menstruation. * **Epistaxis:** 1-1.5 g orally three to four times daily. Topical use (mouthwash) also common. * **Hemorrhagic Cystitis:** 1 g IV or orally three to four times daily. * **Bleeding in Hemophilia (Dental Procedures):** 1 g orally every 6-8 hours, starting pre-operatively and continuing for 2-7 days post-operatively. IV administration may be used in conjunction with factor replacement. * **Post-Prostatectomy Bleeding:** 1 g IV every 6-8 hours. * **Cardiac Surgery:** 5 g IV loading dose followed by 0.5-1 g/hr IV infusion. * **Traumatic Bleeding:** 1 g IV bolus, followed by 1 g IV infusion over 1 hour if within 3 hours of injury. May repeat 1 g IV infusion every 8 hours. *Note: Dosing, particularly for surgical prophylaxis and traumatic bleeding, may vary based on institutional protocols.* ## Pediatric Dosing Limited data for pediatric use. Dosing is often extrapolated from adult data or based on institutional protocols. Common practice for menorrhagia: 10-15 mg/kg/dose orally three to four times daily. ## Dose Adjustments * **Renal Impairment:** Dose reduction is required based on creatinine clearance (CrCl): * CrCl 50-80 mL/min: 50% of usual dose every 12 hours. * CrCl 10-50 mL/min: 25% of usual dose every 12 hours. * CrCl <10 mL/min: 12.5% of usual dose every 12 hours. * *Consider alternative dosing strategies or discontinuation if CrCl is very low.* * **Hepatic Impairment:** No specific dose adjustments are typically recommended, as the drug is not significantly metabolized by the liver. ## Contraindications * Active intravascular clotting or thrombosis (e.g., disseminated intravascular coagulation without anticoagulation). * Hypersensitivity to tranexamic acid. * Acquired defective color vision (if used chronically). * Subarachnoid hemorrhage (associated with increased risk of cerebral edema and infarction). ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal pain. * **Less Common:** Headache, dizziness, rash, injection site reactions. * **Serious:** Thrombotic events (deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke), hypersensitivity reactions, visual disturbances (especially with chronic use), seizures (particularly with rapid IV administration). ## Key Drug Interactions * **Hormonal contraceptives (oral, transdermal, vaginal, injectable, implants):** Increased risk of thromboembolic events. * **Factor VIIa:** Potential for additive thrombotic risk. * **Antifibrinolytics (e.g., aminocaproic acid):** Increased risk of thrombosis. * **Estrogens:** Increased risk of thrombosis. ## Monitoring * Signs and symptoms of thromboembolic events (e.g., leg pain/swelling, chest pain, shortness of breath, neurological deficits). * Visual acuity and color vision (especially with prolonged or high-dose therapy). * Renal function (for dose adjustments). * Evidence of bleeding control. ## Clinical Pearls * Tranexamic acid is most effective when initiated early in the bleeding episode. * For IV administration, use slow injection to minimize hypotension and risk of seizures. * Avoid concomitant use with hormonal contraceptives due to increased thrombotic risk. * If visual disturbances occur, discontinue the drug and perform an ophthalmologic examination. * Ensure adequate hydration and renal function assessment for dose adjustment. *** **Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional and refer to the most current prescribing information for complete details before making any treatment decisions.