Tranexamic Acid
Tranexamic Acid is a synthetic antifibrinolytic agent used to prevent and control excessive bleeding by inhibiting the breakdown of blood clots, commonly applied in trauma care, surgery, and menstrual disorders.
Mechanism of Action:
Tranexamic acid is a synthetic derivative of lysine that exerts antifibrinolytic effects by blocking lysine binding sites on plasminogen molecules, inhibiting the interaction of plasminogen with formed plasmin and fibrin. As a result, inhibition of plasminogen activation results in stabilization of the preformed fibrin meshwork produced by secondary hemostasis.
| Tranexamic acid |
| Availability: injectable solution : Injection: 1,000 mg tranexamic acid (100 mg/mL) in 10 mL single-dose vials ; Tablet : 650mg |
| Administration and Handling: IV Preparation: Prepare solution same day it will be used Dilute a single dose w/t 50 mL compatible fluid (eg, NS, Ringers, dextrose/water) IV Administration 100 mg or fraction thereof over at least 1 min, usually 5 minutes. Avoid rapid infusion Storage: Store at 25°C (77°F) PO: Take this medication by mouth with or without food as directed by your doctor, usually 3 times a day. Swallow this medication whole. Do not crush or chew. |
| Dental Extraction in Patients with Hemophilia: Indicated in patients with hemophilia for short-term use (ie, 2-8 days) to reduce/prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction 10 mg/kg IV immediately before surgery OR 10 mg/kg IV q6-8hr 1 day before surgery 25 mg/kg PO q6-8hr 1 day pre-surgery AND 2-8 days post-surgery. |
| Heavy menstrual bleeding : Tablets : Adults. 1,300 mg three times daily for a maximum of 5 days during monthly menstruation. Do not take it for more than 5 days in a row. |
Indications:
- Menorrhagia
- Epistaxis
- Thrombolytic Overdose
- Prevent excessive bleeding. (dental extraction in Hemophilia)
Cautions and Contraindications:
- Hypersensitivity
- Acquired defective color vision
- Subarachnoid hemorrhage
- Active thromboembolic disease
- Greater than 3 hours from traumatic injury.
Side – Effects:
- GI disturbance
- Disturbance in color vision
- Hypotension (with rapid injection)
- Nausea & Vomiting
- Anaphylaxis
Metabolism and Half- Life:
- Plasma t ½ is between 2-11 hrs.
- Excretion: Urine (95%)
Nursing Considerations
- Monitor lab values, especially coagulation profile.
- Tranexamic acid therapy isn’t recommended for women who use hormonal contraceptives or who take factor IX complex concentrates or anti-inhibitor coagulant concentrates because of the increased risk of thromboembolism.
- Use tranexamic acid cautiously in patients with acute promyelocytic leukemia taking oral tretinoin for remission induction because of possible exacerbation of the pro-coagulant effect of tretinoin.
- Cerebral edema and cerebral infarction may occur in women taking tranexamic acid if a subarachnoid hemorrhage occurs.
- WARNING Monitor patient closely for allergic reactions to tranexamic acid such as dyspnea, a feeling of throat tightness, and facial flushing that may require emergency medical treatment.
- Consider electroencephalogram (EEG) monitoring for patients with history of seizures.
Intervention/ evaluation
- Be alert for bleeding gums, nosebleeds, or other unusual bleeding or bruising that might indicate inadequate drug effects. Report signs of bleeding to the physician immediately.
- Monitor increased blood coagulation, including venous thrombosis (lower extremity swelling, warmth, erythema, tenderness) or arterial thrombosis (extreme coldness in the hands and feet, cyanosis, muscle cramping). Watch for pulmonary embolism (shortness of breath, chest pain, cough, bloody sputum) or arterial thrombosis that could lead to MI or stroke. Notify physician immediately, and request objective tests (Doppler ultrasound, others) if thrombosis is suspected.
- Assess blood pressure and compare to normal values. Report low blood pressure (hypotension), especially if patient develops dizziness or syncope.
- Assess dizziness that might affect gait, balance, and other functional activities. Report balance problems and functional limitations to the physician and caution the patient and family/caregivers to guard against falls and trauma.
Patient teaching
- Instruct patient to swallow tranexamic acid tablets whole, without chewing or breaking them. Therapy shouldn’t exceed 5 days during menstruation.
- Tell patient to seek emergency care immediately if she has any signs of allergic reaction, especially dyspnea, a feeling of throat tightness, and facial flushing, and to stop taking drug.
- Advise patient to report any changes in vision or ocular discomfort.
- Patient should be cautioned about driving, operating machinery, or performing hazardous tasks while taking tranexamic acid
Drug Interactions:
Counters the effects of fibrinolytic agents (e.g., streptokinase, alteplase)
Important Points:
Treatment should be initiated during menstruation when managing menorrhagia.
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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