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
Pharm 101 700

Pharmacology 101

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MBBS CCPU (RCE, Biliary, DVT, E-FAST, AAA) Rob is an Emergency Medicine Advanced Trainee based in Melbourne, Australia. He has special interests in medical education, ECG interpretation, and the use of diagnostic and procedural ultrasound in the undifferentiated and unwell patient.

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