Tranexamic acid
Tranexamic acid is a medication used to treat or prevent excessive blood loss from major trauma, postpartum bleeding, surgery, tooth removal, nosebleeds, and heavy menstruation. It is also used for hereditary angioedema. It is taken either by mouth or injection into a vein.
Side effects are rare. Some include changes in color vision, blood clots, and allergic reactions. Greater caution is recommended in people with kidney disease. Tranexamic acid appears to be safe for use during pregnancy and breastfeeding. Tranexamic acid is in the antifibrinolytic family of medications.
Tranexamic acid was first made in 1962 by Japanese researchers Shosuke and Utako Okamoto. It is on the World Health Organization's List of Essential Medicines. Tranexamic acid is available as a generic medication
Medical uses
Tranexamic acid is frequently used following major trauma. Tranexamic acid is used to prevent and treat blood loss in a variety of situations, such as dental procedures for hemophiliacs, heavy menstrual bleeding, and surgeries with high risk of blood loss.Trauma
Tranexamic acid has been found to decrease the risk of death in people who have significant bleeding due to trauma. Its main benefit is if taken within the first three hours. It has been shown to reduce death due to any cause and death due to bleeding. Further studies are assessing the effect of tranexamic acid in isolated brain injury. Given within three hours of a head injury it also decreases the risk of death.Vaginal bleeding
Tranexamic acid is used to treat heavy menstrual bleeding. When taken by mouth it both safely and effectively treats regularly occurring heavy menstrual bleeding and improves quality of life. Another study demonstrated that the dose does not need to be adjusted in females who are between ages 12 and 16.Child birth
Tranexamic acid is used after delivery to reduce bleeding, often with oxytocin. Death due to postpartum bleeding was reduced in women receiving tranexamic acid.Surgery
- Tranexamic acid is used in orthopedic surgery to reduce blood loss, to the extent of reducing or altogether abolishing the need for perioperative blood collection. It is of proven value in clearing the field of surgery and reducing blood loss when given before or after surgery. Drain and number of transfusions are reduced.
- In surgical corrections of craniosynostosis in children it reduces the need for blood transfusions.
- In spinal surgery, correction with posterior spinal fusion using instrumentation, to prevent excessive blood loss.
- In cardiac surgery, both with and without cardiopulmonary bypass, it is used to prevent excessive blood loss.
Dentistry
Tranexamic acid is used in dentistry in the form of a 5% mouth rinse after extractions or surgery in patients with prolonged bleeding time; e.g., from acquired or inherited disorders.
Hematology
There is not enough evidence to support the routine use of tranexamic acid to prevent bleeding in people with blood cancers. However, there are several trials that are currently assessing this use of tranexamic acid. For people with inherited bleeding disorders, tranexamic acid is often given. It has also been recommended for people with acquired bleeding disorders to treat serious bleeding.Nosebleeds
The use of tranexamic acid, applied directly to the area that is bleeding or taken by mouth, appears useful to treat nose bleeding compared to packing the nose with cotton pledgets alone. It decreases the risk of rebleeding within 10 days.Other uses
- Tentative evidence supports the use of tranexamic acid in hemoptysis.
- In hereditary angioedema
- In hereditary hemorrhagic telangiectasia - Tranexamic acid has been shown to reduce frequency of epistaxis in patients suffering severe and frequent nosebleed episodes from hereditary hemorrhagic telangiectasia.
- In melasma - tranexamic acid is sometimes used in skin whitening as a topical agent, injected into a lesion, or taken by mouth, both alone and as an adjunct to laser therapy; as of 2017 its safety seemed reasonable but its efficacy for this purpose was uncertain because there had been no large scale randomized controlled studies nor long term follow-up studies.
- In hyphema - Tranexamic acid has been shown to be effective in reducing risk of secondary hemorrhage outcomes in people with traumatic hyphema.
Contraindications
- Allergic to tranexamic acid
- History of seizures
- History of venous or arterial thromboembolism or active thromboembolic disease
- Severe kidney impairment due to accumulation of the medication, dose adjustment is required in mild or moderate kidney impairment
Adverse effects
Blood clots may include venous thromboembolism, anaphylaxis. These rare side effects were reported in post marketing experience and frequencies cannot be determined. Despite the mode of action, large studies of the use of tranexamic acid have not shown an increase in the risk of venous or arterial thrombosis.
Special populations
- Tranexamic acid is categorized as pregnancy category B. No harm has been found in animal studies.
- Small amounts appears in breast milk if taken during lactation. If it is required for other reasons, breastfeeding may be continued.
- In kidney impairment, tranexamic acid is not well studied. However, due to the fact that it is 95% excreted unchanged in the urine, it should be dose adjusted in patients with renal impairment.
- In liver impairment, dose change is not needed as only a small amount of the drug is metabolized through the liver.
Mechanism of action
Society and culture
Tranexamic acid was first synthesized in 1962 by Japanese researchers Shosuke and Utako Okamoto. It has been included in the WHO list of essential medicines.Cost
TXA is inexpensive and treatment would be considered highly cost effective in high, middle and low income countries.Brand names
Tranexamic acid is marketed in the U.S. and Australia in tablet form as Lysteda and in Australia and Jordan it is marketed in an IV form and tablet form as Cyklokapron, in the UK as Cyclo-F and Femstrual, in Asia as Transcam, in Bangladesh as Tracid, in India as Pause, in Pakistan as Transamin, in South America as Espercil, in Japan as Nicolda, in France, Belgium and Romania as Exacyl and in Egypt as Kapron. In the Philippines, its capsule form is marketed as Hemostan and In Israel as Hexakapron.Approval
The U.S. Food and Drug Administration approved tranexamic acid oral tablets for treatment of heavy menstrual bleeding on 13 November 2009.In March 2011 the status of tranexamic acid for treatment of heavy menstrual bleeding was changed in the UK, from PoM to P and became available over the counter in UK pharmacies under the brand names of Cyklo-F and Femstrual, initially exclusively for Boots pharmacy, which has sparked some discussion about availability. Regular liver function tests are recommended when using tranexamic acid over a long period of time.