Tranexamic Acid

Introduction

When I was a provisional registered pharmacist, I used to confuse tranexamic acid as a NSAID (cause it sounds similar to mefenamic acid).

On the other hand, it is a medication used to treat or prevent excessive blood loss from major trauma, postpartum bleeding, surgery, tooth removal, nosebleeds and heavy menstruation.

Menorrhagia

Menorrhagia is excessive (heavy) menstrual blood loss (i.e. blood loss of 60-80 ml or more period, compared with average loss of 30-40 ml), which occurs over several consecutive cycles.

Oral tranexamic acid reduces the volume of menstrual blood loss by about half through its antifibrinolytic effect, which increases blood clotting.

• Dosage varies, according to the heaviness and duration of bleeding: 1 to 1.5 g 3 or 4 times daily for the first 3-5 days of each cycle.
• Although tranexamic acid is available as an OTC medication in oversea, it is a prescription medication at Malaysia (Group B poison).

5% Mouthwash

Tranexamic acid can be extemporaneously prepared as a 5% mouthwash to stop dental bleeding, for example in patients on anticoagulant therapy or with haemostatic defects (e.g. haemophilia, von Willebrand disease).

• Dilute 5 ml of tranexamic acid 10% (100 mg/ml) injection with 5 ml sterile water. It is stable for 5 days when refrigerated.
• Dissolve tranexamic acid tablet in 10 ml of water.

Dermatology Use (Off-label)

Melasma

• Dosage: 250 mg twice daily (which is comparable to the cumulative monthly dose used for menorrhagia.
• The reported success rate is up to 89%, with results appearing as early as 8 weeks.

Hereditary angioedema

• Dosage: 1-1.5 g orally 2-3 times daily, as intermittent or continuous treatment, as determined by symptoms.
• 73% of patients reported a reduced frequency of attacks.

Side Effects

Common side effects experienced are mild nausea, vomiting and diarrhoea.

Visual disturbances and thrombotic events have been reported but are very rare.

Contraindications

Tranexamic acid should not be taken by women with current or previous thromboembolic disease, those with a family history of such problems and those taking anticoagulants or oral contraception.

Excretion of tranexamic acid is almost exclusively by the kidneys; therefore, the treatment is not advised for women with mild-to-moderate renal insufficiency.

Haematuria (blood in the urine) from upper urinary tract pathology is a contraindication because a blood clot may cause obstruction in the ureter.

External Links

• Tranexamic acid mouthwash — A prospective randomized study of a 2-day regimen vs 5-day regimen to prevent postoperative bleeding in anticoagulated patients requiring dental extractions, 2003
  
• Role of Non-Steroidal Anti-Inflammatory Drugs in Gynecology, 2010
  
• DermNet - Tranexamic Acid
  
• Oral tranexamic acid (TA) in the treatment of melasma: A retrospective analysis, 2016
  
• Tranexamic acid as maintenance treatment for non-histaminergic angioedema: analysis of efficacy and safety in 37 patients, 2014
  
• Efficacy and safety of tranexamic acid in the treatment of adult melasma: An updated meta-analysis of randomized controlled trials, 2021