Antifibrinolytics, amino acids
ATC code: B02AA02 (Tranexamic acid)
Brand names
Cyklokapron, Lysteda
Competitive plasminogen activation inhibitor at fibrin lysine sites. Suppresses fibrinolysis, stabilizes formed clots, and reduces blood loss. Does not activate coagulation — does not raise pathological thrombosis risk in patients without comorbidities. Short half-life (2 hours); effect develops 1–2 hours after IV administration, slightly later after oral.
First line
Per NG88 and 2024, tranexamic acid is first-line pharmacotherapy for heavy menstrual bleeding without organic pathology. Oral 1 g three to four times daily during the first 3–5 days of menses. Reduces menstrual blood loss by 40–50 %. Effect only during dosing — does not regulate cycles or provide contraception.
First line
First-line for postpartum hemorrhage per 2022 and FIGO 2018. The WOMAN trial (Lancet 2017, over 20,000 patients) showed a 19 % reduction in death from bleeding when given within 3 hours of birth. Dose 1 g IV over 10 minutes, repeat after 30 minutes if bleeding persists. WHO recommends mandatory availability in maternity facilities.
First line
First-line in major trauma with active bleeding per CRASH-2 (Lancet 2010, over 20,000 patients) — 32 % reduction in bleeding death. Efficacy is time-dependent: administration within 3 hours of injury is beneficial; after 3 hours — neutral or harmful. Dose 1 g IV over 10 minutes, then 1 g over 8 hours.
Not recommended
Tranexamic acid in viral URI and sore throat is not mentioned in international guidelines. Common Russian use of nebulized tranexamic acid in pediatric stenotic laryngotracheitis is not supported by evidence — Cochrane reviews do not confirm efficacy. Croup standard care: nebulized epinephrine and systemic corticosteroids (dexamethasone, budesonide).
Justified in postpartum hemorrhage and third-trimester life-threatening bleeding. Per WOMAN-2, TXA may be considered individually for patients at risk of major intrapartum blood loss.
Transfers into milk in minimal amounts. Compatible with breastfeeding per LactMed.
tranexamic acid is evaluated for the following indications with varying evidence strength: Postpartum hemorrhage (evidence tier A), Heavy menstrual bleeding (evidence tier A), Trauma-related bleeding (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of tranexamic acid (≥ 1 in 100): Nausea, diarrhea, Headache, Abdominal pain, Menstrual changes in some patients. See the Safety section for uncommon and serious reactions.
Justified in postpartum hemorrhage and third-trimester life-threatening bleeding. Per WOMAN-2, TXA may be considered individually for patients at risk of major intrapartum blood loss.
Transfers into milk in minimal amounts. Compatible with breastfeeding per LactMed.
tranexamic acid is contraindicated in: Active thromboembolism (PE, DVT, stroke); Personal history of venous or arterial thrombosis; Thrombophilic states; Subarachnoid hemorrhage; Severe renal impairment. Full list in the Safety section.
the bleeding-stopping effect is robustly shown in postpartum, traumatic, and menstrual bleeding. In other settings (epistaxis, GI bleeding) data are limited or absent; baseline care depends on cause.
in patients without thrombophilia or active venous disease, it is safe. Contraindicated in active or recent thromboembolism.
international guidelines do not support use in URI, laryngitis, or sore throat. This is a local Russian practice without an evidence base.