Transfusion medicine handbook

8. Clinical Alternatives and Applications

8.6 Tranexamic Acid

Tranexamic acid is an inhibitor of fibrinolysis.

Use of tranexamic acid carries a risk of clot formation resistant to fibrinolytic therapy and is therefore generally contraindicated in thromboembolic disease and in DIC. Due to the risk of clot-induced hydronephrosis, tranexamic acid is also contraindicated with haematuria/ bleeding from renal parenchyma.

Dose adjustment is required with even mild renal impairment.

Therapeutic Indications [12]

Haemorrhage or risk of haemorrhage in increased fibrinolysis or fibrinogenolysis. Local fibrinolysis may occur in the following conditions:

• Prostatectomy and bladder surgery
• Menorrhagia
• Epistaxis
• Conisation of the cervix
• Management of dental extraction in patients with coagulopathies
• Ulcerative colitis
• Haematuria (Tranexamic acid therapy is not indicated in haematuria caused by diseases of the renal parenchyma)
• Gastrointestinal haemorrhage.
• General fibrinolysis as in prostatic and pancreatic cancer; after thoracic and other major surgery:
• in obstetric complications such as abruptio placentae and post-partum haemorrhage
• in leukaemia and liver diseases and in connection with thrombolytic therapy with streptokinase.
• Hereditary angioneurotic oedema.
• For the reduction of peri- and post-operative blood loss and the need for blood transfusion in adult patients undergoing cardiac surgery or total knee arthroplasty or total hip arthroplasty.
• For the reduction of peri- and post-operative blood loss and the need for blood transfusion in paediatric patients undergoing cardiac surgery.

Dosage and method of administration

For guidance in relation to specific types of surgery, the appropriate data sheet should be reviewed. As general guidance, in the setting of surgery, tranexamic acid 10 - 15 mg/kg administered IV over 10 minutes may be given as preoperative prophylaxis or as therapy for bleeding. Further intravenous infusion or bolus IV doses of 500 - 1000 mg, every 8 hours, may be given. Oral doses up to 1500 mg, administered three to four times daily, may be used for up to 14 days to cover the post-operative period.

For oral mucosal bleeding, experience suggests clinical effect can be achieved from the use of a crude mouth wash made by dispersing 500 mg tranexamic acid tablet to a slurry in 10 - 15 mL water and swirling the total preparation around the mouth for two minutes before expelling. This is used four times daily for up to seven days.