tranexamic acid (Cyclokapron)

see also:

• RACGP patient information sheet (pdf)

• available in oral or iv form to reduce bleeding by increasing tendency to thrombosis
• mainly used for severe menorrhagia / PV bleeding or trauma
• it is an antifibrinolytic which can decrease blood flow in menorrhagia by 50%

• CRASH-2 study¹⁾ compared tranexamic acid vs placebo in trauma patients with, or at risk of significant haemorrhage
  • overall mortality was lower in the tranexamic acid group (14.5 versus 16 percent; RR 0.91, 95% CI 0.85-0.97)
  • death from hemorrhage was lower (4.9 versus 5.7 percent; RR 0.85, 95% CI 0.76-0.96)
  • relative risk of bleeding to death is 0.68 if given within 1 hour of trauma, and 0.79 if given with 1-3hrs of trauma but for some reason appeared to increase mortality from bleeding if given more than 3 hours after death
  • no differences in complications from vascular occlusion (eg, pulmonary embolism (PE), acute myocardial infarction (AMI/STEMI/NSTEMI))
• a study of its use in surgical patients, 60% of whom had cancer showed no increase in DVT risk but a reduction in need for blood transfusion²⁾
• thus early administration within 3 hours of trauma for at risk patients seems to be reasonable

• usual dose: ii x 500mg tablets o qid for 4 days

• usual adult dose for menorrhagia is 1g given either by infusion over 20 minutes
• can dilute to 1g/100 mL (1%) with compatible infusion soln (NaCl 0.9%, glucose 5%, dextran 40, dextran 70, Ringer soln).
• massive transfusion protocol / trauma usage
  • loading dose infusion rate 100 mg/min (ie. 1g over 10 minutes), then, 1 g over 8 hrs
• other usage:
  • loading dose infusion rate 50 mg/min
  • equiv. 0.5 mL/min slow IVI for undiluted soln for inj (1 g/10 mL), 5 mL/min infusion for 1% soln
  • adult cardiac surgery: 15 mg/kg loading dose followed by 4.5 mg/kg/hr for duration of surgery (0.6 mg/kg of infusion dose may be added in priming vol of heart lung machine).
• adult total knee, hip arthroplasty: 15 mg/kg before release of tourniquet (knee) or skin incision (hip), followed by repeat bolus of 15 mg/kg every 8 hr. Admin last bolus 16 hr after initial dose.
• paediatric (greater than or equal to 2 yrs) cardiac surgery: 10 mg/kg as presurgical bolus, then 10 mg/kg as repeat bolus or infusion during surgery.
• renal impairment (eGFR < 90 mL/min/1.73 m2): reduce dose