Tranexamic acid is a medicine that helps stop bleeding: very heavy periods, childbirth bleeding, trauma, surgery and nosebleeds. It does not form clots — it only stops the ones that form from breaking down.
Also known as: Cyklokapron, Exacyl
Tranexamic acid plus ibuprofen may increase the risk of thrombotic events/bleeding complications due to combined haemostatic effects.
Tranexamic acid is an antifibrinolytic; NSAIDs alter haemostasis and platelet function; the combination in menorrhagia is common but requires vigilance (Prontuário entry; EMC).
Thrombotic signs (chest pain, unilateral swelling) and atypical bleeding.
Sudden chest pain, dyspnoea, DVT, prolonged bleeding.
In menorrhagia the combination is accepted with monitoring; assess thrombotic risk factors before combining; limit duration.
INFARMED Prontuário Terapêutico (11th ed., 2012), tranexamic acid entry (haemostatics); DailyMed — Lysteda (tranexamic acid) Tablet label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9d97790f-048b-494d-aa22-5689643a724b
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)
Alcohol irritates the gastric mucosa and transiently inhibits platelet aggregation — it adds gastrointestinal bleeding risk to antifibrinolytic treatment.
Avoid alcohol during treatment, especially at high doses or prolonged use.
Prontuário Terapêutico INFARMED, Annex 6 (alcohol — GI bleeding); site monograph (TXA GI ADRs).
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
Tranexamic acid is antifibrinolytic — it stabilises clots and is contraindicated in active/recent thromboembolic disease.
Exclude active DVT/PE/arterial thrombosis before starting; discontinue if thrombosis signs develop during treatment.
Prontuário Terapêutico INFARMED, 4.3 Anticoagulants and antithrombotics — antifibrinolytics: contraindicated in pro-thrombotic states.
No specific Annex 1 entry; tranexamic acid crosses the placenta and is present in milk. Labels (EMC/Cyklokapron) recommend avoiding in pregnancy unless clearly necessary — postpartum haemorrhage data (Woman trial) are reassuring for fetal outcomes. Do not use in haematuria due to urinary tract thrombosis risk.
Use only if clearly necessary (severe bleeding); PPH use has established benefit — fetal exposure is irrelevant in that context (baby already delivered).
Present in milk in small amounts; the equivalent paediatric dose is low — compatible with monitoring (EMC: "tranexamic acid is present in milk at about 1/100th of maternal serum levels").
In women of childbearing age, document the decision to treat.
EMC-UK (MHRA) — Tranexamic Acid SmPC (Cyklokapron): https://www.medicines.org.uk/emc/product/2168/smpc (section 4.6). WOMAN trial (Lancet 2017).
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Fibrinolysis blockade: bleeding control without generalised coagulation activation; ↓ trauma mortality if < 3 h.
Lysine analogue: binds the kringle-1/4 domain of plasminogen, preventing its binding to fibrin and conversion to plasmin; also inhibits already-formed plasmin activity.
Oral: 30–50% (saturable at high dose); IV: 100%; limited volume of distribution (~ 9–12 L).
Minimally metabolised (< 5%); unchanged renal excretion (adjust in renal failure).
~ 2–3 h (IV); longer antifibrinolytic effect.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
