Tranexamic acid

Tranexamic acid is an antifibrinolytic agent. It interferes with the fibrinolysis of newly formed clots by binding to the lysine-binding sites of plasminogen thus inhibiting its binding to fibrin. Administration can be oral, intravenous, or topical (e.g., as mouthwash). It can be used alone (e.g., in the management of epistaxis and menorrhagia) or in combination with DDAVP or VWF concentrates. To increase its effectiveness, tranexamic acid should be given prior to elective procedures and with repetitive dosing to ensure concentrations in tissues as well.

Available products in the Nordic countries

Tranexamic acid solution for injection (100 mg/mL) and tablets of 500 mg. In Sweden, and on special permission in Denmark, dissolvable tablets (1g) are available. In Sweden, also oral solution with 100mg/ml is available, especially for children.

Dose and modes of administration

Orally 20-25 mg per kg BW 3- 4 times daily for 7-10 days.

Intravenously 10 mg per kg BW 3-4 times daily for 7-10 days.

Mouthwash 10 mL of a 5% solution 4 times daily, which can be swallowed.

Limitations with tranexamic acid

  • Contraindicated in the management of upper urinary tract bleeds.

  • Dose reduction is necessary in patients with renal insufficiency.

  • Should be avoided, or its usage minimized, in patients with a recent thromboembolism and/or a previous personal thromboembolic disease and/or strong risk factors for thrombosis.

  • No data are available on the use of tranexamic acid in newborns.

Adverse effects with tranexamic acid

The adverse effects include nausea, vomiting, diarrhea, and abdominal pain.