Pharmacology

Tranexamic Acid

Tranexamic acid (“TXA”, Cyklokapron) is an analog of the amino acid lysine that works as an antifibrinolytic by binding lysine receptor sites on plasminogen to competitively inhibit its conversion to plasmin – the enzyme responsible for degrading fibrin clots. It’s roughly ten times more potent than aminocaproic acid (another antifibrinolytic), but in comparison, has a slighter higher incidence of seizures. Both agents seem to work equally well to reduce bleeding in cardiac surgery, obstetric hemorrhage, orthopedic/spine surgery, and trauma.

The 2010 CRASH-2 randomized trial showed that TXA conferred an improvement in one month survival when administered early to trauma patients with known or suspected significant hemorrhage based on hemodynamics.

As an anesthesiologist, I routinely bolus TXA and use it in my infusion carrier set during various cardiac surgeries (with or without cardiopulmonary bypass) to mitigate coagulopathy. As an intensivist, I’ll sometimes give a gram of TXA if coagulopathic patients have thromboelastograms (TEGs) with a reduction in their LY30 values indicative of excessive fibrinolysis.

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