Tranexamic acid

Tranexamic acid is a synthetic derivative of the amino acid lysine. It is commonly marketed in the U.S. and Australia in tablet form as Lysteda and in IV form It is used to treat or prevent excessive blood loss during surgery and in various other medical conditions. It is anantifibrinolytic that competitively inhibits the activation of plasminogen to plasmin, by binding to specific sites of both plasminogen and plasmin, a molecule responsible for the degradation of fibrin, a protein that forms the framework of blood clots. Tranexamic acid has roughly eight times theantifibrinolytic activity of an older analogue, ε-aminocaproic acid.

Medical uses

Tranexamic acid is frequently used in surgeries with high risk of blood loss such as cardiac, liver, vascular and large orthopedic procedures. Its oral form is now being evaluated for use in outpatient conditions involving heavy bleeding.

Trauma

Tranexamic acid has been found to decrease the risk of death in people who have significant bleeding due to trauma. However, it may actually increase the risk of death due to bleeding if administered more than 3 hours after the injury.

Heart surgery

Tranexamic acid is commonly used in cardiac surgery, both with and without cardiopulmonary bypass. It replaces aprotinin.

Menstrual bleeding

Used as firstline nonhormonal treatment of dysfunctional uterine bleeding, and heavy bleeding associated with uterine fibroids. An August 2007 study showed patients treated with tranexamic acid are more likely to develop thrombosis and necrosis in their fibroids, and may result in pain and fever.The histological appearance of the necrosis in women treated by tranexamic acid is no different from the spontaneous incidence of thrombosis. The U.S. Food and Drug Administration (FDA) approved tranexamic acid oral tablets (brand name Lysteda) for treatment of heavy menstrual bleeding on 13 November 2009.

In March 2011 the status of Tranexamic acid for treatment of heavy menstrual bleeding was changed in the UK, from PoM (Prescription only Medicines) to P (Pharmacy Medicines)and became available over the counter in UK pharmacies under the brand names of Cyklo-F and Femstrual, initially exclusively for Boots pharmacy, which has sparked some discussion about availability.

Tranexamic acid is used in orthopedic surgery to reduce blood loss. It is of proven value in clearing the field of surgery and reducing pre- and postoperative blood loss. Drain and number of transfusions are reduced. However, the hidden blood loss is not reduced. Still, it is becoming an important tool in the anaesthetist's arsenal. It is commonly used in joint replacement surgery.

Craniofacial surgery

Use of tranexamic acid in surgical corrections of craniosynostosis in children reduces the need for blood transfusions.