Tranexamic acid is a medication used to treat or prevent excessive

blood loss Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, v ...

from

major trauma Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Dependi ...

postpartum bleeding Postpartum bleeding or postpartum hemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood following childbirth. Some have added the requirement that there also be signs or symptoms of low blood volume f ...

, surgery, tooth removal,

nosebleed A nosebleed, also known as epistaxis, is an instance of bleeding from the nose. Blood can flow down into the stomach, and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significa ...

s, and heavy menstruation. It is also used for

hereditary angioedema Hereditary angioedema (HAE) is a disorder that results in recurrent attacks of severe swelling. The swelling most commonly affects the arms, legs, face, intestinal tract, and airway. If the intestinal tract is affected, abdominal pain and vo ...

. It is taken either

by mouth Oral administration is a route of administration whereby a substance is taken through the Human mouth, mouth, swallowed, and then processed via the digestive system. This is a common route of administration for many medications. Oral administ ...

injection into a vein Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutr ...

, or by intramuscular injection. Tranexamic acid is a synthetic

analog Analog or analogue may refer to: Computing and electronics * Analog signal, in which information is encoded in a continuous variable ** Analog device, an apparatus that operates on analog signals *** Analog electronics, circuits which use analog ...

of the

amino acid Amino acids are organic compounds that contain both amino and carboxylic acid functional groups. Although over 500 amino acids exist in nature, by far the most important are the 22 α-amino acids incorporated into proteins. Only these 22 a ...

lysine Lysine (symbol Lys or K) is an α-amino acid that is a precursor to many proteins. Lysine contains an α-amino group (which is in the protonated form when the lysine is dissolved in water at physiological pH), an α-carboxylic acid group ( ...

. It serves as an

antifibrinolytic Antifibrinolytics are a class of medication that are inhibitors of fibrinolysis. Examples include aminocaproic acid (ε-aminocaproic acid) and tranexamic acid. These lysine Lysine (symbol Lys or K) is an α-amino acid that is a precursor ...

by reversibly binding four to five lysine receptor sites on

plasmin Plasmin is an important enzyme () present in blood that degrades many blood plasma proteins, including fibrin thrombus, clots. The degradation of fibrin is termed fibrinolysis. In humans, the plasmin protein (in the zymogen form of plasminogen) i ...

ogen. This decreases the conversion of plasminogen to plasmin, preventing

fibrin Fibrin (also called Factor Ia) is a fibrous protein, fibrous, non-globular protein involved in the Coagulation, clotting of blood. It is formed by the action of the protease thrombin on fibrinogen, which causes it to polymerization, polymerize. ...

degradation and preserving the framework of fibrin's matrix structure. Tranexamic acid has roughly eight times the antifibrinolytic activity of an older analogue, ε-aminocaproic acid. Tranexamic acid also directly inhibits the activity of plasmin with weak potency ( IC₅₀ = 87 mM), and it can block the active-site of

urokinase plasminogen activator Urokinase, also known as urokinase-type plasminogen activator (uPA), is a serine protease present in humans and other animals. The human urokinase protein was discovered, but not named, by McFarlane and Pilling in 1947. Urokinase was originally ...

(uPA) with high specificity ( Ki = 2 mM), one of the highest among all the

serine proteases Serine proteases (or serine endopeptidases) are enzymes that cleave peptide bonds in proteins. Serine serves as the nucleophilic amino acid at the (enzyme's) active site. They are found ubiquitously in both eukaryotes and prokaryotes. Seri ...

. Side effects are rare; they include changes in

color vision Color vision, a feature of visual perception, is an ability to perceive differences between light composed of different frequencies independently of light intensity. Color perception is a part of the larger visual system and is mediated by a co ...

seizures A seizure is a sudden, brief disruption of brain activity caused by abnormal, excessive, or synchronous neuronal firing. Depending on the regions of the brain involved, seizures can lead to changes in movement, sensation, behavior, awareness, o ...

blood clots A thrombus ( thrombi) is a solid or semisolid aggregate from constituents of the blood (platelets, fibrin, red blood cells, white blood cells) within the circulatory system during life. A blood clot is the final product of the blood coagulati ...

, and

allergic reaction Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include Allergic rhinitis, hay fever, Food allergy, food al ...

s. Tranexamic acid appears to be safe for use during pregnancy and breastfeeding. Tranexamic acid is an

medication. Tranexamic acid was first made in 1962 by Japanese researchers Shosuke and

Utako Okamoto was a Japanese medical doctor working as a medical scientist who discovered tranexamic acid in the 1950s in her quest to find a drug that would treat bleeding after childbirth ( post-partum haemorrhage). After publishing results in 1962 she bec ...

. It is on the

World Health Organization's List of Essential Medicines The WHO Model List of Essential Medicines (aka Essential Medicines List or EML), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health s ...

. Tranexamic acid is available as a

generic drug A generic drug is a pharmaceutical drug that contains the same chemical substance as a drug that was originally protected by chemical patents. Generic drugs are allowed for sale after the patents on the original drugs expire. Because the active ch ...

Uses

Medical uses

Tranexamic acid is frequently used following major trauma. Tranexamic acid is used to prevent and treat blood loss in a variety of situations, such as dental procedures, heavy menstrual bleeding, and surgeries with high risk of blood loss.

Trauma

Tranexamic acid has been found to decrease the risk of death due to any cause in people who have significant bleeding due to

trauma Trauma most often refers to: *Psychological trauma, in psychology and psychiatric medicine, refers to severe mental and emotional injury caused by distressing events *Traumatic injury, sudden physical injury caused by an external force, which doe ...

. It is most effective if taken within the first three hours following major trauma. It also decreases the risk of death if given within the first three hours of brain injury.

Menstrual bleeding

Tranexamic acid is sometimes used to treat heavy menstrual bleeding. When taken by mouth it both safely and effectively treats regularly occurring heavy menstrual bleeding and improves quality of life. Another study demonstrated that the dose does not need to be adjusted in females who are between ages 12 and 16. In a 10-year study, tranexamic acid and other oral medicines (mefenamic acid) were found to be as effective as the levonorgestrel intrauterine coil; the same proportion of women had not had surgery for heavy bleeding and had similar improvements in their quality of life.

Childbirth

Tranexamic acid is sometimes used (often in conjunction with

oxytocin Oxytocin is a peptide hormone and neuropeptide normally produced in the hypothalamus and released by the posterior pituitary. Present in animals since early stages of evolution, in humans it plays roles in behavior that include Human bonding, ...

) to reduce bleeding after childbirth. Death due to

is reduced in women receiving tranexamic acid.

Surgery

* Tranexamic acid is sometimes used in

orthopedic surgery Orthopedic surgery or orthopedics ( alternative spelling orthopaedics) is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...

to reduce blood loss, to the extent of reducing or altogether abolishing the need for perioperative blood transfusion. It is of proven value in clearing the field of surgery and reducing blood loss when given before or after surgery. Drain and number of transfusions are reduced. * In surgical corrections of

craniosynostosis Craniosynostosis is a condition in which one or more of the fibrous sutures in a young infant's skull prematurely fuses by turning into bone (ossification), thereby changing the growth pattern of the skull. Because the skull cannot expand perpe ...

in children it reduces the need for blood transfusions. * In spinal surgery (e.g.,

scoliosis Scoliosis (: scolioses) is a condition in which a person's Vertebral column, spine has an irregular curve in the coronal plane. The curve is usually S- or C-shaped over three dimensions. In some, the degree of curve is stable, while in others ...

), correction with posterior spinal fusion using instrumentation, to prevent excessive blood loss. * In cardiac surgery, both with and without

cardiopulmonary bypass Cardiopulmonary bypass (CPB) or heart-lung machine, also called the pump or CPB pump, is a machine that temporarily takes over the function of the heart and lungs during open-heart surgery by maintaining the circulation of blood and oxygen throug ...

(e.g.,

coronary artery bypass surgery Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage"), is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest ...

), it is used to prevent excessive blood loss.

Dentistry

In the United States, tranexamic acid is FDA-approved for short-term use in people with severe bleeding disorders who are about to have dental surgery. Tranexamic acid is used for a short period before and after the surgery to prevent major blood loss and decrease the need for blood transfusions. Tranexamic acid is used in dentistry in the form of a 5% mouth rinse after extractions or surgery in patients with prolonged bleeding time; e.g., from acquired or inherited disorders. In China, tranexamic acid is allowed in over-the-counter toothpaste, with six products using the drug. , there are no limits on dosage, nor requirements for labeling the concentration. 0.05% TXA in toothpaste is allowed OTC in Hong Kong. <5% TXA in over-the-counter toothpaste is first patented and marketed by

Lion Corporation is a Japanese multinational manufacturer of detergent, soap, medications, and oral hygiene products and other toiletries. The company also has a chemical engineering Chemical engineering is an engineering field which deals with the study of ...

in Japan, where it is still sold. Presence of unauthorized TXA has led to the Canadian recall of a

Yunnan Baiyao Yunnan Baiyao (or Yunnan Paiyao; ) is a proprietary traditional Chinese medicine marketed and used as a hemostatic product in both human and veterinary alternative medicine. Although Yunnan Baiyao has long been recognized as a pharmaceutical pr ...

toothpaste in 2019.

Hematology

There is not enough evidence to support the routine use of tranexamic acid to prevent bleeding in people with blood cancers. However, several trials are currently assessing this use of tranexamic acid. For people with inherited bleeding disorders (e.g.

von Willebrand's disease Von Willebrand disease (VWD) is the most common hereditary blood-clotting disorder in humans. An acquired form can sometimes result from other medical conditions. It arises from a deficiency in the quality or quantity of von Willebrand factor ( ...

), tranexamic acid is often given. It has also been recommended for people with acquired bleeding disorders (e.g., directly acting oral anticoagulants (DOACs)) to treat serious bleeding.

Nosebleeds

The use of tranexamic acid, applied directly to the area that is bleeding or taken by mouth, appears useful to treat

nose bleeding A nosebleed, also known as epistaxis, is an instance of bleeding from the nose. Blood can flow down into the stomach, and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significan ...

compared to packing the nose with cotton pledgets alone. It decreases the risk of rebleeding within 10 days.

Cosmetic Uses

Tranexamic acid can be used in skincare products as a cosmetic active to reduce the appearance of inflammation and hyperpigmentation. Tranexamic acid is a

zwitterion In chemistry, a zwitterion ( ; ), also called an inner salt or dipolar ion, is a molecule that contains an equal number of positively and negatively charged functional groups. : (1,2- dipolar compounds, such as ylides, are sometimes excluded from ...

amino acid, and has a low permeability coefficient in the

stratum corneum The stratum corneum (Latin language, Latin for 'horny layer') is the outermost layer of the epidermis (skin), epidermis. Consisting of dead tissue, it protects underlying tissue from infection, dehydration, chemicals and mechanical stress. It is ...

. Tranexamic acid can be combined with penetration enhancers and microneedling to overcome this limitation. Cosmetic uses may also employ lipophilic derivatives of tranexamic acid (ester prodrugs like

Cetyl tranexamate mesylate Cetyl tranexamate mesylate (sold under the trade name TXVector) is a bioavailable derivative of tranexamic acid for use in cosmetic formulations. Its primary use is in skincare products aimed at enhancing appearance by targeting hyperpigmentation ...

) that are not zwitterionic and thus have improved skin permeability.

Contraindications

* Allergic to tranexamic acid * History of seizures * History of venous or arterial thromboembolism or active thromboembolic disease * Severe kidney impairment due to accumulation of the medication, dose adjustment is required in mild or moderate kidney impairment

Adverse effects

Side effects are rare. Reported adverse events include

, changes in

blood clot A thrombus ( thrombi) is a solid or semisolid aggregate from constituents of the blood (platelets, fibrin, red blood cells, white blood cells) within the circulatory system during life. A blood clot is the final product of the blood coagulatio ...

s, and

s such as

anaphylaxis Anaphylaxis (Greek: 'up' + 'guarding') is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of the use of emergency medication on site. It typicall ...

. Whether the risk of

venous thromboembolism Venous thrombosis is the blockage of a vein caused by a thrombus (blood clot). A common form of venous thrombosis is deep vein thrombosis (DVT), when a blood clot forms in the deep veins. If a thrombus breaks off ( embolizes) and flows to the lun ...

(blood clots) is increased is a matter of debate. The risk is mentioned in the product literature, and they were reported in post marketing experience. Despite this, and the inhibitory effect of tranexamic acid on blood clot breakdown, large studies of the use of tranexamic acid have not shown an increase in the risk of venous or arterial thrombosis, even in people who had previously experienced thrombosis under other circumstances.

Special populations

* For pregnancy, no harm has been found in animal studies. * Small amounts appear in breast milk if taken during lactation.

Society and culture

Tranexamic acid was first synthesized in 1962 by Japanese researchers Shosuke and

. It is on the

Brand names

Tranexamic acid is marketed in the US and Australia in tablet form as Lysteda and in Australia, Sweden and Jordan it is marketed in an IV form and tablet form as Cyklokapron, in the UK and Sweden as Cyclo-F. In the UK it is also marketed as Femstrual, in Asia as Transcam, in Bangladesh as Intrax & Tracid, in India as Pause, in Pakistan as Transamin, in Indonesia as Kalnex, in South America as Espercil, in Japan as Nicolda, in France, Poland, Belgium, and Romania as Exacyl and in Egypt as Kapron. In the Philippines, its capsule form is marketed as Hemostan and in Israel as Hexakapron.

Legal status

The US Food and Drug Administration (FDA) approved tranexamic acid oral tablets (brand name Lysteda) for the treatment of heavy menstrual bleeding in November 2009. In March 2011, the status of tranexamic acid for the treatment of

heavy menstrual bleeding Heavy menstrual bleeding (HMB), previously known as menorrhagia or hematomunia, is a menstruation, menstrual period with excessively heavy flow. It is a type of abnormal uterine bleeding (AUB). Abnormal uterine bleeding can be caused by stru ...

was changed in the UK, from POM (Prescription only Medicines) to P (Pharmacy Medicines) and became available

over the counter Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid pres ...

in UK pharmacies under the brand names of Cyklo-F and Femstrual.

Research

Tranexamic acid might alleviate

neuroinflammation Neuroinflammation is inflammation of the nervous tissue. It may be initiated in response to a variety of cues, including infection, traumatic brain injury,Ebert SE, Jensen P, Ozenne B, Armand S, Svarer C, Stenbaek DS ''et al.'' Molecular imaging of ...

in some experimental settings. Tranexamic acid can be used in case of postpartum hemorrhage; it can decrease the risk of death due to bleeding by one third according to the WHO. Tentative evidence supports the use of tranexamic acid in

hemoptysis Hemoptysis or haemoptysis is the discharge of blood or blood-stained sputum, mucus through the mouth coming from the bronchi, larynx, vertebrate trachea, trachea, or lungs. It does not necessarily involve coughing. In other words, it is the airw ...

. In

hereditary hemorrhagic telangiectasia Hereditary hemorrhagic telangiectasia (HHT), also known as Osler–Weber–Rendu disease and Osler–Weber–Rendu syndrome, is a rare autosomal dominant genetic disorder that leads to abnormal blood vessel formation in the Human skin, skin, muco ...

: tranexamic acid has been shown to reduce the frequency of

epistaxis A nosebleed, also known as epistaxis, is an instance of bleeding from the nose. Blood can flow down into the stomach, and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significan ...

in patients with severe and frequent nosebleed episodes from hereditary hemorrhagic telangiectasia. In

melasma Melasma (also known as chloasma faciei,James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. . or the mask of pregnancy when present in pregnant women) is a tan or dar ...

: tranexamic acid is sometimes used in skin whitening as a topical agent, injected into a lesion, or taken by mouth, both alone and as an adjunct to laser therapy; as of 2017 its safety seemed reasonable but its efficacy for this purpose was uncertain because there had been no large scale randomized controlled studies nor long term follow-up studies. It is allowed as a quasi-drug for skin whitening in Japan. In

hyphema Hyphema is the medical condition of bleeding in the anterior chamber of the eye between the iris and the cornea. People usually first notice a loss or decrease in vision. The eye may also appear to have a reddish tinge, or it may appear as a s ...

: tranexamic acid is effective in reducing the risk of secondary hemorrhage outcomes in people with traumatic hyphema. In

liver The liver is a major metabolic organ (anatomy), organ exclusively found in vertebrates, which performs many essential biological Function (biology), functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of var ...

resection: tranexamic acid did not reduce bleeding or transfusions but did increase complications.

References

{{Authority control Amino acids Antifibrinolytics Cyclohexanecarboxylic acids Non-proteinogenic amino acids Wikipedia medicine articles ready to translate Transfusion medicine World Health Organization essential medicines Skin whitening Aminomethyl compounds