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tranexamic_acid

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tranexamic acid (Cyclokapron)

  • avoid in patients with:
    • thrombophilia or thromboembolic disease such as DVT or PE
    • thrombotic stroke risk
    • pregnancy
    • lactation
    • age < 15 years
    • severe renal disease
    • severe bruising
    • bleeding in body cavities

see also:

introduction

  • 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%

trauma

  • 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))
  • thus early administration within 3 hours of trauma for at risk patients seems to be reasonable

dose

oral dose

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

iv dose:

  • 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).
    • 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
1)
Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. CRASH-2 trial collaborators, Shakur H at al. 2010;376(9734):23
tranexamic_acid.txt · Last modified: 2017/02/22 14:32 (external edit)