Antihaemorrhagic (antifibrinolytic)
Tranexamic acid is an antifibrinolytic medicine used to reduce bleeding: it prevents the breakdown of clots, helping to stop bleeding. It is used to treat heavy menstrual bleeding (menorrhagia), postoperative or traumatic bleeding, and in patients at bleeding risk. It should be used with caution in patients with a history of thrombosis.
Also known as: Cyklokapron, tranexamic acid, ácido tranexâmico
Tranexamic acid combined with enoxaparin increases thrombotic risk; assess the indication carefully.
There is no documented pharmacokinetic interaction between tranexamic acid (an antifibrinolytic — it inhibits fibrin dissolution by plasmin) and enoxaparin (an anticoagulant); the problem is the combination of opposing haemostasis mechanisms: the tranexamic acid label contraindicates the drug in patients with active thromboembolic disease or an intrinsic risk of thrombosis, and the enoxaparin label warns about the bleeding risk with drugs that affect haemostasis. The combination occurs in acute bleeding situations in anticoagulated patients (e.g. trauma, major haemorrhage) where the antifibrinolytic is used for bleeding control — a clinical risk/benefit decision. During the combination, watch for bleeding and thrombosis signs (DVT, PE, vascular occlusion) and monitor the blood count; tranexamic acid should be stopped if visual symptoms or suspected retinal occlusion occur.
Tranexamic acid + enoxaparin: antifibrinolytic + anticoagulant — opposing haemostasis mechanisms. Assess risk/benefit and watch thrombosis/bleeding.
The antifibrinolytic reduces clot lysis while LMWH enhances anticoagulation; the balance is paradoxical and thrombotic risk is additive in at-risk patients.
Monitor for signs of DVT, pulmonary embolism and bleeding.
Limb pain or swelling, sudden dyspnoea, persistent bleeding.
Use only when bleeding outweighs thrombotic risk; monitor for signs of thrombosis.
DailyMed (FDA) — approved Tranexamic acid label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4877eacd-fda7-4708-93a5-81052c1d2e14 ; approved Enoxaparin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5017a927-2a24-4f27-89f9-27c805bf7d59 — additional reference: Prontuário Terapêutico do INFARMED (11th ed., 2012)
Tranexamic acid can be administered with or without food; taking it with food may reduce gastrointestinal irritation.
May be taken with or without food, consistently.
DailyMed/FDA — Tranexamic Acid Tablets label (Northstar Rx): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4877eacd-fda7-4708-93a5-81052c1d2e14
No relevant pharmacokinetic interaction; alcohol can increase thrombotic risk in predisposed patients — moderation.
Moderate alcohol intake during treatment.
DailyMed/FDA — Tranexamic Acid Tablets label (Northstar Rx): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4877eacd-fda7-4708-93a5-81052c1d2e14
Tranexamic acid is contraindicated in active thrombosis and in patients with a history of thromboembolism because of its antifibrinolytic effect.
Do not use in active thrombosis; assess thrombotic risk before starting.
EMC-UK (MHRA) — approved Tranexamic acid SmPC: https://www.medicines.org.uk/emc/product/1077/smpc
Tranexamic acid crosses the placenta; data are limited and use should be judicious.
Use only if the benefit outweighs the risk (e.g. severe postpartum haemorrhage).
Excreted into breast milk in small amounts; occasional use is compatible.
In women of childbearing age, document the decision to treat.
EMC-UK (MHRA) — approved Tranexamic acid SmPC: https://www.medicines.org.uk/emc/product/1077/smpc
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Antifibrinolytic (synthetic lysine analogue) used to treat heavy menstrual bleeding in women of reproductive potential; reduces blood loss by inhibiting fibrin clot breakdown.
Competitively inhibits the activation of plasminogen to plasmin (binding to the lysine-binding sites), blocking fibrinolysis and stabilising the fibrin clot; also directly inhibits plasmin at high doses.
Oral bioavailability ~45% (women aged 18-49); plasma peak ~3 h (Tmax 2.5 h, 1-5 h); Cmax 13.8 mcg/mL after 1300 mg; food slightly increases Cmax and AUC (+7%/+16%). Protein binding ~3%.
Minimal metabolism; predominantly renal excretion unchanged (~95%) by glomerular filtration and tubular secretion — accumulates in renal impairment (adjust the dose).
Terminal half-life ~11 h (t1/2 11.08 h after a single dose); beta half-life ~2 h; initial volume of distribution 0.18 L/kg.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
