Indications

Bleeding in Presence of Hyperfibrinolysis (see Hyperfibrinolytic States, [[Hyperfibrinolytic States]])

• Post-Cardiopulmonary Bypass (CPB) (see Cardiopulmonary Bypass, [[Cardiopulmonary Bypass]])

Plasminogen Activator Inhibitor-1 (PAI-1) Deficiency (see Plasminogen Activator Inhibitor-1 Deficiency, [[Plasminogen Activator Inhibitor-1 Deficiency]])

• xxxx

Von Willebrand Disease (see Von Willebrand Disease, [[Von Willebrand Disease]])

• xxxx

Trauma (see Trauma-General, [[Trauma-General]])

• Clinical Efficacy
  • Systematic Review of Anti-Fibrinolytics in Acute Trauma (Cochrane Database Syst Rev, 2015) [MEDLINE]
    • Tranexamic Acid Decreased Mortality Rate in Trauma with Hemorrhage without Increasing the Risk of Adverse Effects
    • Tranexamic Acid Should Be GIven within 3 hrs of Injury: treatment later than 3 hrs is likely to be ineffective or harmful (data from CRASH-2 Trial)
    • Unclear if Tranexamic Acid Has Efficacy in Traumatic Brain Injury (TIB) (see Traumatic Brain Injury, [[Traumatic Brain Injury]])

---

Pharmacology

• Anti-Fibrinolytic (see Anti-Fibrinolytics, [[Anti-Fibrinolytics]]): lysine analogue which binds to kringle domains of plasminogen, disrupting interaction between plasminogen (and plasmin) and lysine residues within fibrin
  • Epsilon Aminocaproic Acid (see Epsilon Aminocaproic Acid, [[Epsilon Aminocaproic Acid]]): binds plasminogen (and plasmin) 1/8 as avidly as tranexamic acid -> may exert a less potent anti-hemorrhagic effect

Metabolism

• xxxx

---

Administration

• IV:

Dose Adjustment

• Hepatic
• Renal

---

Adverse Effects

Other Adverse Effects

• xxx

---

References

• Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376:23–32 [MEDLINE]
• Antifibrinolytic drugs for acute traumatic injury. Cochrane Database Syst Rev. 2015 May 9;(5):CD004896. doi: 10.1002/14651858.CD004896.pub4. [MEDLINE]