Tranexamic Acid is a synthetic lysine analogue and antifibrinolytic agent that competitively inhibits the activation of plasminogen to plasmin. It is a first-line therapeutic agent for the management and prevention of excessive bleeding across multiple clinical scenarios, particularly in the Indian context where it is widely used for menorrhagia, surgical prophylaxis, and trauma.
Adult: Menorrhagia: 1g (two 500mg tablets) orally three times daily for up to 5 days during menstruation. Surgical Prophylaxis: 10-15 mg/kg IV before incision, followed by 1g oral TDS for 5-7 days. General Oral: 500mg to 1g two to three times daily as per indication.
Note: Tablets should be swallowed whole with water, with or after food to minimize GI upset. For menorrhagia, start treatment at the onset of heavy bleeding. Do not crush or chew.
Tranexamic acid competitively inhibits the activation of plasminogen to plasmin by binding to the lysine-binding sites on plasminogen. This prevents plasmin from degrading fibrin clots, fibrinogen, and other plasma proteins, thereby stabilizing clots and reducing bleeding.
Pregnancy: Category B. Should be used only if clearly needed. Data from several studies, including the WOMAN trial, support its use in postpartum hemorrhage where benefits outweigh risks.
Driving: May cause dizziness or visual disturbances. Patients should be cautioned about driving or operating machinery if affected.
| Combined Hormonal Contraceptives (Pills, patches) | Synergistic increase in thrombotic risk. | Major |
| Factor IX Complex Concentrates / Anti-inhibitor Coagulant Concentrates | Increased risk of thrombosis. | Major |
| Tretinoin (All-trans retinoic acid) in APL | Increased risk of thrombosis. | Major |
| Other Antifibrinolytics (e.g., Aminocaproic acid) | Additive effect, increased risk of side effects. | Moderate |
| Tissue Plasminogen Activators (tPA, Alteplase) | Tranexamic acid may decrease the efficacy of thrombolytics. | Moderate |
Same composition (Tranexamic Acid (500mg)), different brands: