Tranexamic Acid

How it works

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

Prescribing in practice

• Avoid in patients with active thromboembolic disease and use caution where there is a high thrombotic risk, as inhibiting clot breakdown may favour thrombosis.
• It is contraindicated in disseminated intravascular coagulation unless under specialist guidance and in a history of convulsions for some routes; dose reduction is needed in renal impairment.
• In urinary tract bleeding it can cause clot retention and obstruction, so use cautiously in haematuria of upper urinary tract origin.

Monitoring

Monitor the clinical bleeding response and renal function, and remain alert for any features of thromboembolism.

Counselling the patient

• For heavy periods, take only during the days of bleeding as directed.
• Report calf pain or swelling, chest pain, breathlessness or visual disturbance.
• Seek advice if bleeding is not controlled.

Evidence & guidelines

The CRASH-2 trial showed early tranexamic acid reduces death from bleeding in trauma, and it is recommended for heavy menstrual bleeding by NICE.