Obstetrics & Gynaecology/Antifibrinolytic

Tranexamic acid

also: TXA · antifibrinolytic

Overview

Antifibrinolytic that reduces bleeding — postpartum haemorrhage (WOMAN trial), heavy menstrual bleeding, and trauma/surgery.

Mechanism

Competitively blocks the lysine-binding sites on plasminogen → prevents its conversion to plasmin → fibrin clot is not broken down (clot stabilisation).

Indications

Postpartum haemorrhage (give early, alongside uterotonics)
Heavy menstrual bleeding
Trauma haemorrhage (CRASH-2), surgical bleeding

Adverse effects

GI upset (nausea, diarrhoea)common

Thromboembolism (theoretical)serious

Caution with active thrombotic disease.

Visual disturbance (rare, long-term)common

Cautions & contraindications

Active thromboembolic diseaseall

History of seizures (high IV doses)all

Interactions

Caution with other prothrombotic agents

Monitoring & kinetics

Clinical bleeding response

Oral or IV. In PPH give within 3 hours for benefit.

Choosing it

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Source: BNF — Antifibrinolytics · RCOG — PPH