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Antifibrinolytic Pregnancy: B — indicated for major haemorrhage in pregnancy and PPH

Tranexamic Acid (TXA)

Brand names: Cyclokapron, Cyklokapron

Adult dose

Dose: 1g IV over 10 min
Route: IV
Frequency: Second dose 1g IV over 8 hours if haemorrhage continues
Max: 2g (trauma). Higher doses in surgery: 15–25mg/kg
Trauma haemorrhage: give within 3 hours of injury (evidence-based). PPH: 1g IV, repeat if ongoing bleeding after 30 min. Elective surgery: 15mg/kg IV at induction.

Paediatric dose

Dose: 15 mg/kg
Route: IV over 10–20 min
Frequency: Single dose
Max: 1000mg
Concentration: 100 mg/ml

Dose adjustments

Renal

Reduce dose in renal impairment — renally excreted.

Paediatric weight-based calculator

Clinical pearls

  • CRASH-2 trial: TXA within 3h of injury reduces trauma mortality. NNT ≈ 67 overall; NNT = 6 if within 1h.
  • TXA given >3h after injury may increase mortality — time-critical. Treat-and-transport, do not delay.
  • WOMAN trial: TXA reduces PPH death from haemorrhage by 19% (NNT = 267) — give as soon as PPH diagnosed.
  • TXA does NOT cause net thrombosis at standard trauma doses — it is antifibrinolytic, not directly prothrombotic.
  • Give slowly over ≥10 min — rapid bolus causes hypotension and nausea.

Contraindications

  • Active thromboembolic disease (DVT, PE, arterial thrombosis)
  • History of convulsions (high doses lower seizure threshold)
  • Haematuria from upper urinary tract — clot may obstruct ureter
  • Subarachnoid haemorrhage (controversial — risk of delayed cerebral ischaemia)

Side effects

  • Nausea and vomiting
  • Hypotension if given too rapidly
  • Seizures at very high doses (cardiac surgery doses)
  • Thromboembolic events (theoretical with prolonged use at standard trauma doses)

Interactions

  • Factor IX complex / prothrombin complex concentrate: increased thrombosis risk
  • Oral contraceptives: additive prothrombotic risk

Monitoring

  • Haemoglobin
  • clinical haemostasis
  • BP during infusion

Reference: BNFc; CRASH-2 Trial, Lancet 2010; WOMAN Trial, Lancet 2017; NICE TA65. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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