Tranexamic acid is a synthetic derivative of the amino acid lysine. It functions as an antifibrinolytic agent, which means it inhibits the breakdown of fibrin in blood clots. This property makes it valuable in managing conditions involving excessive bleeding.

Dosage Forms and Strengths

Tranexamic acid is available in several dosage forms, including:

• Oral Tablets: Typically available in strengths of 250 mg and 500 mg.
• Injectable Solution: Available as a 100 mg/mL solution in vials.
• Topical Solution: Used in certain surgical procedures or to treat local bleeding, available as a 4% solution.

Brand and Generic Names

Tranexamic acid is marketed under several brand names, including:

• Lysteda (oral tablets)
• Cyklokapron (injectable form)
• Transamin (available in some regions for both oral and injectable forms)

The generic name for tranexamic acid is simply "tranexamic acid."

Indications for Use

Tranexamic acid is indicated for a variety of conditions, including:

• Menorrhagia: Heavy menstrual bleeding.
• Postoperative Bleeding: To reduce bleeding during and after surgeries.
• Trauma: To manage bleeding in trauma patients.
• Dental Procedures: To control bleeding in patients with bleeding disorders.

Mechanism of Action

Tranexamic acid exerts its effects by inhibiting the activation of plasminogen to plasmin. Plasmin is an enzyme responsible for breaking down fibrin, a protein essential for blood clot formation. By blocking this process, tranexamic acid helps stabilize blood clots and reduce bleeding.

Administration and Dosage

The dosage of tranexamic acid varies depending on the condition being treated:

• Menorrhagia: The usual dosage is 1 g orally two to three times daily, starting from the beginning of menstruation and continuing for 4-5 days.
• Postoperative Bleeding: An intravenous dose of 10-15 mg/kg is typically administered just before or during surgery.
• Trauma: In cases of trauma, tranexamic acid may be administered as an intravenous bolus of 1 g, followed by an infusion of 1 g over 8 hours.

Dosages should be adjusted based on the patient's condition, severity of bleeding, and response to the medication.

Effects and Precautions

Effects:

• Positive: Effective in reducing bleeding and stabilizing blood clots, leading to decreased need for blood transfusions and improved surgical outcomes.
• Side Effects: Common side effects include nausea, vomiting, diarrhea, and abdominal pain. Rare but serious side effects include thromboembolic events (such as deep vein thrombosis or pulmonary embolism), allergic reactions, and visual disturbances.

Precautions:

• Renal Impairment: Dosage adjustments may be necessary in patients with kidney problems, as tranexamic acid is primarily excreted through the kidneys.
• Thromboembolic Disorders: Caution is advised in patients with a history of blood clots or those at risk for thromboembolic events.
• Pregnancy and Lactation: Tranexamic acid should be used during pregnancy only if clearly needed, and its safety during lactation has not been fully established.

Conclusion

Tranexamic acid is a valuable medication in the management of bleeding disorders due to its antifibrinolytic properties. With its various dosage forms and strengths, it is suitable for treating conditions ranging from menorrhagia to postoperative bleeding. While generally well-tolerated, it requires careful consideration of potential side effects and precautions, particularly in patients with pre-existing conditions or those at higher risk for thromboembolic events. Its effective role in stabilizing blood clots underscores its importance in both surgical and non-surgical settings.