ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Antifibrinolytic Pregnancy: Considered safe for postpartum haemorrhage (WHO recommends); limited data for other indications.

Tranexamic Acid

Brand names: Cyklokapron, Cyclokapron

Adult dose

Dose: Trauma/haemorrhage: 1 g IV over 10 min, then 1 g IV over 8 hours; Menorrhagia: 1 g oral three times daily
Route: IV or oral
Frequency: Trauma: loading + infusion within 3 hours of injury; Oral: three times daily during menstruation
Max: 3 g/day IV (trauma); 4 g/day oral (menorrhagia)
Trauma (CRASH-2): 1g IV over 10 min within 3 hours of injury, then 1g over 8 hours. After 3 hours from injury — no benefit/harmful. PPH: 1g IV; if bleeding continues after 30 min, repeat 1g. Menorrhagia: 1–1.5 g three times daily for up to 4 days.

Paediatric dose

Dose: 15 mg/kg
Route: IV
Frequency: Loading over 10 min; maintenance 2 mg/kg/hour
Max: 1000 mg loading
Concentration: 100 mg/ml
15 mg/kg IV (max 1g) over 10 min. Maintenance: 2 mg/kg/hour. For dental procedures in haemophilia: 25 mg/kg oral/IV three times daily for 3 days.

Dose adjustments

Renal

Reduce dose: eGFR 20–50: 10 mg/kg BD; eGFR 10–20: 10 mg/kg daily; eGFR <10: 5 mg/kg daily.

Hepatic

No specific adjustment required.

Paediatric weight-based calculator

15 mg/kg IV (max 1g) over 10 min. Maintenance: 2 mg/kg/hour. For dental procedures in haemophilia: 25 mg/kg oral/IV three times daily for 3 days.

Clinical pearls

  • CRASH-2 trial: reduces mortality in trauma haemorrhage if given within 3 hours
  • Must give within 3 hours of injury — no benefit and potential harm after
  • First-line for menorrhagia — reduces menstrual blood loss by ~50%
  • Oral/topical/IV routes all available
  • Used perioperatively (cardiac surgery, total joint replacement) to reduce blood loss

Contraindications

  • Active thromboembolic disease
  • Haematuria (can cause ureteric obstruction by clot)
  • History of convulsions (high-dose IV)

Side effects

  • Nausea and vomiting
  • Diarrhoea
  • Hypotension (if IV given too rapidly)
  • Thromboembolic events (theoretical)
  • Seizures (high-dose IV — especially cardiac surgery)
  • Visual disturbances

Interactions

  • Factor IX complex concentrates — increased thrombosis risk
  • Anti-inhibitor coagulant complex — combined with TXA may increase thrombosis

Monitoring

  • Response to bleeding
  • Signs of thromboembolism
  • Renal function (dose adjustment)

Reference: BNFc; BNF; CRASH-2 trial (Lancet 2010); WHO PPH guidelines; NICE NG24. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Drugs
Pathways