Tranexamic acid

Antifibrinolytic·Haematology - Anticoagulants & Haemostatics

Major trauma/bleeding, heavy menstrual bleeding, prevention of bleeding in surgery (orthopaedics, cardiac)

PBSANTIFIBRINOLYTICCyklokapron, Cyclo-F500 mg tabletS4+1

Max Dose

4 g/day (PO)

Half-life

3 h

Seizure Risk

HIGH IV DOSE

Clotting

PROMOTES

Rapid Summary

Overview

Potent antifibrinolytic agent. Works by stopping the body from breaking down existing blood clots. Highly effective for massive trauma, severe menstrual bleeding, and post-partum haemorrhage.

Maximum Dose

Max 4 g/day (PO). Massive IV doses used in trauma (e.g., 1g STAT).

Clinical Focus

Can cause seizures if given in massive IV boluses. Must be dose-reduced in renal failure.

Bottom Line

Tranexamic acid is an antifibrinolytic essential for trauma haemorrhage, heavy menstrual bleeding, and surgical bleeding, but must be given within 3 hours of trauma and is contraindicated in active thromboembolic disease.

Formulation & Access

Brand Names

Cyklokapron, Cyclo-F

Oral Routes

Tablets (500 mg).

Parenteral

Ampoules (1 g/10 mL) for IV injection/infusion.

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Major trauma/bleeding, heavy menstrual bleeding, prevention of bleeding in surgery (orthopaedics, cardiac).

Clinical Place

The gold-standard drug to 'stop the bleeding'. Carried by paramedics globally for major trauma.

Quick reference

Class & Role

Antifibrinolytic — Potent antifibrinolytic agent.

Route / Formulation

Tablets (500 mg). (Cyklokapron, Cyclo-F)

Usual Dose & Max

IV 1 g over 10 mins STAT, followed by 1 g infused over 8 hours. (MUST be given within 3 hours of injury). Max 4 g/day (PO). Massive IV doses used in trauma (e.g., 1g STAT).

Key Indication Doses

Massive Trauma (CRASH-2 Protocol): IV 1 g over 10 mins STAT, followed by 1 g infused over 8 hours. (MUST be given within 3 hours of injury). Heavy Menstrual Bleeding: PO 1 g TDS to QID for up to 4 days during menstruation. Max 4 g/day. Dental Extraction (on DOAC/Warfarin): PO 1 g TDS for 2 days, or as a 5% mouthwash swish and spit.

Best Uses

Avoid / Cautions

Active intravascular clotting (e.g., active severe DVT/PE or ischemic stroke), subarachnoid hemorrhage (causes cerebral edema/infarction).

Key Risks

Cardiovascular: Hypotension (if pushed rapidly IV). Theoretical increased risk of VTE (DVT/PE). Neurological: Seizures (Convulsions occur with massive IV doses > 2g, often seen in cardiac surgery). Gastrointestinal: Nausea, diarrhea, vomiting (Very common with high oral doses).

Key Interactions

Combined Oral Contraceptive Pill (COCP). Using TXA and estrogen together synergistically increases the risk of a fatal DVT or PE.

Monitoring

If infusing IV, monitor BP to ensure it does not crash. Check eGFR prior to prescribing long-term oral courses.

Clinical Pearl

In major trauma, TXA saves lives, but ONLY if given within 3 hours of the injury. If given *after* 3 hours, the CRASH-2 trial showed it paradoxically *increases* mortality due to DIC and microvascular clotting. Time is critical.

Access

Cyklokapron, Cyclo-F500 mg tablet

Brand: Cyklokapron, Cyclo-F
Formulation: Tablets (500 mg)