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.
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.
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.
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 (e.g., scoliosis), correction with posterior spinal fusion using instrumentation, to prevent excessive blood loss.
In the United States, tranexamic acid is FDA approved for short-term use in people with severe bleeding disorders who are about to have dental surgery. Tranexamic acid is used for a short period of time before and after the surgery to prevent major blood loss and decrease the need for blood transfusions.
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.[needs update]
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 (e.g. von Willebrand's disease), tranexamic acid is often given. It has also been recommended for people with acquired bleeding disorders (e.g., directly acting oral anticoagulants (DOACs)) to treat serious bleeding.
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.
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.
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
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. TXA is inexpensive and treatment would be considered highly cost effective in high, middle and low income countries.
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 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.
The U.S. Food and Drug Administration (FDA) approved tranexamic acid oral tablets (brand name Lysteda) 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 (Prescription only Medicines) to P (Pharmacy Medicines) 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. (In parts of Europe it had then been available OTC for over a decade.) Regular liver function tests are recommended when using tranexamic acid over a long period of time.
^ abcdBritish national formulary: BNF 69 (69 ed.). British Medical Association. 2015. p. 170. ISBN9780857111562.
^Melvin JS, Stryker LS, Sierra RJ (December 2015). "Tranexamic Acid in Hip and Knee Arthroplasty". The Journal of the American Academy of Orthopaedic Surgeons. 23 (12): 732–40. doi:10.5435/JAAOS-D-14-00223. PMID26493971.
^Napolitano LM, Cohen MJ, Cotton BA, Schreiber MA, Moore EE (June 2013). "Tranexamic acid in trauma: how should we use it?". The Journal of Trauma and Acute Care Surgery. 74 (6): 1575–86. doi:10.1097/TA.0b013e318292cc54. PMID23694890.
^ ab"Tranexamic acid". Clinical Transfusion. International Society of Blood Transfusion (ISBT).
^"Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial". The Lancet. October 2019. doi:10.1016/S0140-6736(19)32233-0.
^Lukes AS, Moore KA, Muse KN, Gersten JK, Hecht BR, Edlund M, Richter HE, Eder SE, Attia GR, Patrick DL, Rubin A, Shangold GA (October 2010). "Tranexamic acid treatment for heavy menstrual bleeding: a randomized controlled trial". Obstetrics and Gynecology. 116 (4): 865–75. doi:10.1097/AOG.0b013e3181f20177. PMID20859150.
^Naoulou B, Tsai MC (May 2012). "Efficacy of tranexamic acid in the treatment of idiopathic and non-functional heavy menstrual bleeding: a systematic review". Acta Obstetricia et Gynecologica Scandinavica. 91 (5): 529–37. doi:10.1111/j.1600-0412.2012.01361.x. PMID22229782.
^ abHenry, David A; Carless, Paul A; Moxey, Annette J; O'Connell, Dianne; Stokes, Barrie J; Fergusson, Dean A; Ker, Katharine (16 March 2011), "Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion", in The Cochrane Collaboration (ed.), Cochrane Database of Systematic Reviews, John Wiley & Sons, Ltd, doi:10.1002/14651858.cd001886.pub4, PMC4234031
^van Galen KP, Engelen ET, Mauser-Bunschoten EP, van Es RJ, Schutgens RE (December 2015). "Antifibrinolytic therapy for preventing oral bleeding in patients with haemophilia or Von Willebrand disease undergoing minor oral surgery or dental extractions". The Cochrane Database of Systematic Reviews (12): CD011385. doi:10.1002/14651858.CD011385.pub2. PMID26704192.
^Logan JK, Pantle H (November 2016). "Role of topical tranexamic acid in the management of idiopathic anterior epistaxis in adult patients in the emergency department". American Journal of Health-System Pharmacy. 73 (21): 1755–1759. doi:10.2146/ajhp150829. PMID27769971.
^Williams A, Biffen A, Pilkington N, Arrick L, Williams RJ, Smith ME, Smith M, Birchall J (December 2017). "Haematological factors in the management of adult epistaxis: systematic review". The Journal of Laryngology and Otology. 131 (12): 1093–1107. doi:10.1017/S0022215117002067. PMID29280698.
^Klepfish A, Berrebi A, Schattner A (March 2001). "Intranasal tranexamic acid treatment for severe epistaxis in hereditary hemorrhagic telangiectasia". Archives of Internal Medicine. 161 (5): 767. doi:10.1001/archinte.161.5.767. PMID11231712.
^Zhou LL, Baibergenova A (September 2017). "Melasma: systematic review of the systemic treatments". International Journal of Dermatology. 56 (9): 902–908. doi:10.1111/ijd.13578. PMID28239840.
^Taraz M, Niknam S, Ehsani AH (May 2017). "Tranexamic acid in treatment of melasma: A comprehensive review of clinical studies". Dermatologic Therapy. 30 (3): e12465. doi:10.1111/dth.12465. PMID28133910.
^Chornenki, Nicholas L. Jackson; Um, Kevin J.; Mendoza, Pablo A.; Samienezhad, Ashkan; Swarup, Vidushi; Chai-Adisaksopha, Chatree; Siegal, Deborah M. (July 2019). "Risk of venous and arterial thrombosis in non-surgical patients receiving systemic tranexamic acid: A systematic review and meta-analysis". Thrombosis Research. 179: 81–86. doi:10.1016/j.thromres.2019.05.003. PMID31100632.