Tranexamic Acid

Tranexamic acid is an antifibrinolytic employed in blood conservation. It acts by inhibiting plasminogen activation.

Uses
Uncontrolled haemorrhage following prostatectomy or dental extraction in haemophiliacs
Haemorrhage due to thrombolytic therapy
Haemorrhage associated with DIC with predominant activation of the fibrinolytic system

Contraindications
Thrombo-embolic disease
DIC with predominant activation of coagulation system

Administration
• Uncontrolled haemorrhage following prostatectomy or dental extraction in haemophiliacs
Slow IV: 500–1000 mg 8 hourly, given over 5–10 min (100 mg/min)

• Haemorrhage due to thrombolytic therapy
Slow IV: 10 mg/kg, given at 100 mg/min

• Haemorrhage associated with DIC with predominant activation
of the fibrinolytic system (prolonged PT, ↓ fibrinogen, ↑fibrinogen degradation products)

Slow IV: 1000 mg over 10 min, single dose usually sufficient Heparin should be instigated to prevent fibrin deposition

In renal impairment:

CC (ml/min)	Dose (mg/kg)	Interval
20–50	10	12 hourly
10–20	10	every 12–24 h
<10	5	every 12–24 h

How not to use tranexamic acid
Rapid IV bolus

Adverse effects
Dizziness on rapid IV injection
Hypotension on rapid IV injection
Cautions
Renal impairment (reduce dose)

Organ failure
Renal: reduce dose

Renal replacement therapy
CVVH unknown dialysability, dose as in CC 10–20 ml/min, i.e. 10 mg/kg every 12–24 hours. HD/PD unknown dialysability, CC <10 ml/min, i.e. 5 mg/kg every 12–24 hours.