ADMINISTRATION ROUTES:
IV
ALTERNATIVE NAMES:
Cyklokapron, TXA
ICU INDICATIONS:
- Bleeding post cardiac surgery or other bleeding due to fibrinolysis
- Major trauma with significant bleeding risk
PRESENTATION AND ADMINISTRATION:
IV:
Clear colourless liquid presented as 500 mg in 5 mL glass vial
Preferred method of administration is via direct IV injection at a rate of 1 mL (100 mg) per minute
Can be administered by intermittent infusion by adding dose to a suitable volume of compatible IV fluid and infusing at a rate of 100 mg/min
Compatible with the following IV fluids: Normal saline, 5% dextrose. Do not mix with blood products or solutions containing penicillins.
Store at room temperature. Use dilutions in IV fluid within 24 hours of preparation
Can be prepared as 5% topical solution by mixing IV preparation with Water for Injection. Place on swab and apply directly to reduce bleeding at fistula or other bleeding sites (nose bleed, dental surgery)
DOSAGE:
IV:
10 - 25 mg/kg TDS
Major trauma:
1 g over 10 mins then 1 g over 8 hrs by infusion
PO:
1 - 1.5 g QID or BD
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose in renal impairment
| GFR (ml/min) | DOSE |
|---|---|
| <10 | 5 mg/kg OD |
| 10-20 | 10 mg/kg OD |
| >20-50 | 10 mg/kg BD |
Dose in renal replacement therapy
| MODALITY | DOSE |
|---|---|
| CAPD | 5 mg/kg OD |
| HD | 5 mg/kg OD |
| CVVHDF | 10 mg/kg OD |
DOSAGE IN PAEDIATRICS:
IV:
10 - 20 mg/kg TDS
CLINICAL PHARMACOLOGY:
Tranexamic acid is an antifibrinolytic. It reversibly binds to lysine receptor sites on plasminogen. This decreases conversion of plasminogen to plasmin which prevents fibrin degradation. It has minimal metabolism and is renally eliminated with a half-time of 2 hours.
CONTRAINDICATIONS:
- Previous DVT or PE
- Hypersensitivity to tranexamic acid
WARNINGS:
Procoagulant effects
Tranexamic acid may cause thrombotic complications; it should be used with caution in patients at risk of such complications.
PRECAUTIONS: General:
See WARNINGS
Laboratory Tests:
No tests additional to routine ICU tests are required
Drug/Laboratory Test Interactions:
None known
IMPORTANT DRUG INTERACTIONS IN ICU:
None of note
ADVERSE REACTIONS:
General:
Allergic reactions, thrombotic events
Cardiovascular:
Hypotension (particularly with rapid injection)
Gastrointestinal:
Nausea, vomiting, diarrhoea
Neurological:
Impaired colour vision and other visual disturbances