Antifibrinolytic·Haematology - Anticoagulants & Haemostatics

Tranexamic acid

Major trauma/bleeding, heavy menstrual bleeding, prevention of bleeding in surgery (orthopaedics, cardiac)

PBSANTIFIBRINOLYTICCyklokapron, Cyclo-F500 mg tabletS4+1

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At a glance

Max Dose

4 g/day (PO)

Half-life

3 h

Caution: Seizure Risk

HIGH IV DOSE

Clotting

PROMOTES

Cautions

Avoid / Cautions

Active intravascular clotting (e.g., active severe DVT/PE or ischemic stroke), subarachnoid hemorrhage (causes cerebral edema/infarction).

Where it stands

Rapid Summary

Overview

Potent antifibrinolytic agent. Works by stopping the body from breaking down existing blood clots. Highly effective for massive trauma, severe menstrual bleeding, and post-partum haemorrhage.

Clinical Focus

Can cause seizures if given in massive IV boluses. Must be dose-reduced in renal failure.

Bottom Line

Tranexamic acid is an antifibrinolytic essential for trauma haemorrhage, heavy menstrual bleeding, and surgical bleeding, but must be given within 3 hours of trauma and is contraindicated in active thromboembolic disease.

Formulation & Access

Brand Names

Cyklokapron, Cyclo-F

Oral Routes

Tablets (500 mg).

Parenteral

Ampoules (1 g/10 mL) for IV injection/infusion.

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Major trauma/bleeding, heavy menstrual bleeding, prevention of bleeding in surgery (orthopaedics, cardiac).

Clinical Place

The gold-standard drug to 'stop the bleeding'. Carried by paramedics globally for major trauma.

Quick reference

Class & Role

Antifibrinolytic — Potent antifibrinolytic agent.

Route / Formulation

Tablets (500 mg). (Cyklokapron, Cyclo-F)

Usual Dose & Max

IV 1 g over 10 mins STAT, followed by 1 g infused over 8 hours. (MUST be given within 3 hours of injury). Max 4 g/day (PO). Massive IV doses used in trauma (e.g., 1g STAT).

Key Indication Doses

Massive Trauma (CRASH-2 Protocol): IV 1 g over 10 mins STAT, followed by 1 g infused over 8 hours. (MUST be given within 3 hours of injury). Heavy Menstrual Bleeding: PO 1 g TDS to QID for up to 4 days during menstruation. Max 4 g/day. Dental Extraction (on DOAC/Warfarin): PO 1 g TDS for 2 days, or as a 5% mouthwash swish and spit.

Best Uses

Key Risks

Cardiovascular: Hypotension (if pushed rapidly IV). Theoretical increased risk of VTE (DVT/PE). Neurological: Seizures (Convulsions occur with massive IV doses > 2g, often seen in cardiac surgery). Gastrointestinal: Nausea, diarrhea, vomiting (Very common with high oral doses).

Key Interactions

Combined Oral Contraceptive Pill (COCP). Using TXA and estrogen together synergistically increases the risk of a fatal DVT or PE.

Monitoring

If infusing IV, monitor BP to ensure it does not crash. Check eGFR prior to prescribing long-term oral courses.

Clinical Pearl

In major trauma, TXA saves lives, but ONLY if given within 3 hours of the injury. If given *after* 3 hours, the CRASH-2 trial showed it paradoxically *increases* mortality due to DIC and microvascular clotting. Time is critical.

Access

Cyklokapron, Cyclo-F500 mg tablet

Brand: Cyklokapron, Cyclo-F
Formulation: Tablets (500 mg).

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