Tranexamic Acid 500mg Tablets (Epistaxis)

How it works

It is a synthetic lysine analogue that competitively blocks the lysine-binding sites on plasminogen, inhibiting its conversion to plasmin and thereby stabilising formed clots by preventing fibrinolysis.

Prescribing in practice

• It is contraindicated in active thromboembolic disease and a history of venous or arterial thromboembolism, and should be used cautiously where thrombotic risk is high.
• The dose should be reduced in renal impairment because the drug is renally cleared and can accumulate.
• It does not replace mechanical control of active bleeding such as pressure, cautery or packing.

Monitoring

No routine laboratory monitoring is required for short courses; review bleeding control and remain alert to any symptoms of thromboembolism.

Counselling the patient

• Take it as an addition to first-aid measures like pinching the soft part of the nose.
• Seek urgent help for chest pain, breathlessness or a painful swollen leg.
• Tell the prescriber if you have had blood clots or have kidney problems.

Evidence & guidelines

Antifibrinolytic therapy is recognised as a useful adjunct in epistaxis, though local control measures remain the mainstay.