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Tranexamic acid
Systematic (IUPAC) name
	trans-4-(aminomethyl)cyclohexanecarboxylic acid
Identifiers
CAS number	1197-18-8
ATC code	B02AA02
PubChem	5526
DrugBank	APRD01270
ChemSpider	10482000
Chemical data
Formula	C8H15NO2
Mol. mass	157.21 g/mol
SMILES	eMolecules & PubChem
Pharmacokinetic data
Bioavailability	34%
Metabolism	?
Half life	3.1 h
Excretion	?
Therapeutic considerations
Pregnancy cat.	B
Legal status
Routes	Injection and oral
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Tranexamic acid (commonly marketed as Cyklokapron in the U.S. and as Transamin,Transcam in Asia, and Espercil in South America) is often prescribed for excessive bleeding. It is an antifibrinolytic that competitively inhibits the activation of plasminogen to plasmin, a molecule responsible for the degradation of fibrin. Fibrin is the basic framework for the formation of a blood clot in hemostasis. It has roughly 8 times the antifibrinolytic activity of an older analogue, ε-aminocaproic acid.

[edit] Therapeutic uses

[edit] Menstrual bleeding

Tranexamic acid (cyklokapron, transamin) is a synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. It inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of clot. Side effects are uncommon. While prolonged treatment may heighten the risk of an increased thrombotic tendency, such as deep vein thrombosis, large scale studies reveal that the incidence of thrombosis in women treated by tranexamic acid is no different from the spontaneous incidence of thrombosis in women. Tranexamic acid is used as firstline nonhormonal treatment of dysfunctional uterine bleeding, and heavy bleeding associated with uterine fibroids. A recent study showed that patients treated with tranexamic acid are more likely to develop thrombosis and necrosis in their fibroids, and may result in pain and fever. Moreover, the histological appearance of the necrosis in women treated by tranexamic acid is no different from the spontaneous incidence of thrombosis in women. The U.S. Food and Drug Administration (FDA) approved tranexamic acid oral tablets (brand name Lysteda) for treatment of heavy menstrual bleeding on November 16, 2009.

[edit] Obstetrics

Tranexamic acid is used post-delivery to reduce bleeding, often along with syntocinon/oxytocin and fundal massage.

[edit] Hemophilia

Tranexamic acid is also useful in the treatment of bleeding as a second line treatment next to factor VIII in patients (i.e. Tooth extraction in patient

[edit] Cardiac surgery

Tranexamic acid is used in cardiac surgery, e.g. coronary artery bypass surgery, to prevent excessive blood loss.

[edit] Orthopedic Surgery

Tranexamic acid is used in orthopedic surgery to reduce bloodloss. It is of proven value in clearing the field of surgery and reducing pre and postoperative blood loss. Drain and number of transfusion is 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.

[edit] Dentistry

Tranexamic acid is used in dentistry in the form of a mouth rinse after extractions or surgery in patients with prolonged bleeding time e.g. from acquired or inherited disorders.

[edit] References

Patient Experience with Tranexamic Acid (Patient Experience)
Tranexamic acid (Dr. P.L.F. Giangrande, Oxford Haemophilia Centre)
Tranexamic acid (UK patient information leaflet)
Types of Angioedema and treatments (Hereditary Angioedema Association)

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