Tranexamic acid
Class: antifibrinolytic, haemostatic
Indications: haemorrhage – surface bleeding from tumours, nose and other organs (some indications are unlicensed)
Contraindications/cautions: acute bleeding, active clotting, urinary tract bleeds (as clots may rarely form in the urinary tract), renal dysfunction, subarachnoid haemorrhage, acquired defective colour vision
Adverse reactions: common: GI upset (nausea,vomiting,diarrhoea) – reduce dose; less common: dizziness (iv), thrombocytopenia, headache, restlessness, impaired colour vision
Interactions:
- decreased clinical effect of anticoagulants e.g. warfarin & others may occur with tranexamic acid
| Dosing: | |
|---|---|
| Haemorrhage: | |
| oral: | 1 to 1.5 g 3 to 4 times a day |
| subcut: | can be used in 50ml WFI or saline by short infusion |
| topical: | the injection has been used topically on bleeding wounds |
| iv: | 0.5 to 1 g 2 to 3 times a day |
| Control of surface (mucosal or epidermal) bleeding:: | |
| Oral: | 1.5 g stat then 1 g tds – discontinue 1 week after bleeding stops or reduce to 500 mg tds |
| Mouthwash: | dissolve one 500 mg tablet in 10 mL of water and use as a mouthwash qid – rinse mouth then swallow |
Syringe driver: 1000 mg to 2000 mg in WFI or saline over 24 hours
Mechanism of action: interacts with plasminogen to cause antifibrinolysis
Peak effect: 3 hours
Notes:
- tablets are large and many patients may have difficulty swallowing them
- tablets are dispersable in water & can be used to make a mouthwash
- in palliative care, a benefit versus risk assessment should be applied to cautions and contra-indications when making prescribing decisions
- evidence for use subcut & in syringe driver in the UK
- 1 g PO = 500 mg subcut
- reduce dose if eGFR < 50 mL/min/1.73 m^2