Tranexamic Acid (Surgical / Trauma Haemorrhage)

How it works

It binds the lysine sites on plasminogen, blocking its conversion to plasmin and thereby inhibiting fibrinolysis, which stabilises formed clots and reduces bleeding.

Prescribing in practice

• In significant traumatic or surgical haemorrhage early administration improves outcome, so give it promptly and ideally within the first hours of injury, after which benefit declines.
• Use cautiously where there is active thromboembolic disease, a strong thrombotic tendency, or disseminated intravascular coagulation, and reduce exposure in renal impairment as it is renally cleared.
• Rapid intravenous injection can cause hypotension, so administer the infusion slowly.

Monitoring

Monitor bleeding control, haemodynamic status and renal function, remaining alert for any clinical signs of thromboembolism.

Counselling the patient

• Report calf swelling or pain, chest pain, or breathlessness, which may signal a clot.
• Visual changes are rare but should be reported, particularly with longer oral courses.

Evidence & guidelines

The CRASH-2 and WOMAN trials and UK major-haemorrhage protocols support early tranexamic acid in trauma and surgical bleeding.