Tranexamic Acid

How it works

It competitively blocks the lysine-binding sites on plasminogen, preventing its conversion to plasmin and so inhibiting fibrinolysis and stabilising formed clots.

Prescribing in practice

• Avoid in active thromboembolic disease and use with caution where there is a history of venous or arterial thrombosis, since inhibiting clot breakdown can promote thrombosis; in trauma it should be given early as benefit falls with delay.
• Intravenous injection should be given slowly to limit hypotension, and the dose must be reduced in renal impairment because the drug is renally cleared and can accumulate.
• It is contraindicated in a history of convulsions and in subarachnoid haemorrhage outside specialist protocols, and accidental intrathecal administration can cause seizures and death.

Monitoring

Monitor for signs of thromboembolism and, with prolonged treatment, consider eye examinations for visual disturbance; assess renal function to guide dosing.

Counselling the patient

• For heavy periods, take only during bleeding days as directed.
• Report leg swelling or pain, chest pain or breathlessness.
• Stop and seek advice if you develop visual disturbance on long-term use.

Evidence & guidelines

Its survival and bleeding benefits are supported by the CRASH-2 and WOMAN trials and endorsed in NICE trauma and major haemorrhage guidance.