Pharm 101: Tranexamic Acid
Class
Fibrinolytic inhibitor
Pharmacodynamics
- Tranexamic acid is an analog of aminocaproic acid, a synthetic inhibitor of fibrinolysis which competitively inhibits plasminogen activation
Pharmacokinetics
- Rapid oral absorption
- Minimal protein binding due to binding plasmin
- Minimal metabolism
- Renal excretion
Clinical uses
- Epistaxis
- Haemoptysis
- Menorrhagia
- Haemorrhagic shock (including trauma, surgical haemorrhage)
- Reduced peri-operative bleeding
- Reversal of thrombolytic therapy
- Dosage is usually 1g PO/IV, q6-8h depending on exact indication
Adverse effects
- Intravascular thrombosis due to inhibition of plasminogen activator
- Myopathy
- Hypotension (usually with rapid IV infusion)
- GI upset when taken orally
Precautions/contraindications
- Active intravascular clotting (DIC)
- Upper renal tract bleeding due to possibility of clot retention
- Dose reduction in renal failure
Further reading
- Nickson C. Tranexamic Acid. LITFL
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Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Co-creator of the LITFL ECG Library. Twitter: @rob_buttner