see also:
#drugs
evidence show benefit if given <3 hours after injury
| Indication | yes/no | evidence | |
| ----------------------------- | ------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --- |
| GI Bleeding (upper and lower) | No | [HALT-IT](https://www.thebottomline.org.uk/summaries/halt-it/) | |
| Trauma | **Yes** | NNT 66, given ==within 3 hours== <br>[MATTERs, CRASH-2](https://rebelem.com/tranexamic-acid-txa-for-everything-that-bleeds/). <br>[PATCH](https://www.thebottomline.org.uk/summaries/icm/patch-2/): debate as pre-hospital and bad functional outcomes | |
| SAH | No | [Ultra](https://www.thebottomline.org.uk/summaries/ultra/) | |
| TBI haemorrhagic | **maybe** (is safe) | [CRASH-3](https://www.thebottomline.org.uk/summaries/crash-3/) | |
| Spont ICH | no, but safe | [TICH-2](https://www.thebottomline.org.uk/summaries/icm/tich-2/) | |
| Epstaxis | **probably** | topical TXA [meta-analysis](https://rebelem.com/meta-analysis-on-topical-txa-for-epistaxis/), [NoPAC](https://first10em.com/nopac-no-benefit-from-txa-in-epistaxis/), [ACEM](https://acem.org.au/getmedia/95b9db1c-da96-489f-b541-9b7948ccdd6b/1330-Mani-Rajee-PRESENTATION) | |
| Haemoptysis (non-massive) | **maybe** nebulised | poor evidence [Tranexamic Acid for Hemoptysis: A Review](https://journals.lww.com/clinpulm/Abstract/2017/03000/Tranexamic_Acid_for_Hemoptysis__A_Review.4.aspx), [Small RCT](https://rebelem.com/txa-for-everyone-inhaled-txa-for-hemoptysis/) | |
| Heavy menstrual bleeding | **yes**, but not as good as IUD | [TXA Menorrhagia](https://www.obgproject.com/2018/05/22/txa-measure-treatment-menorrhagia/) | |
| Post partum haemorrhage | **probably** | Certainly yes for safety. NNT 250 [WOMAN trial](https://www.thebottomline.org.uk/summaries/icm/woman-trial/), [WOMAN commentary](https://broomedocs.com/2017/05/thoughts-woman-trial/), [WOMAN-2 Trial ongoing](https://clinicaltrials.gov/ct2/show/NCT03475342) | |
# pharmacology
| cat | explain |
| ------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| class | - serine protease inhibitor<br>- synthetic derivative of amino acid lysine |
| admin | IV, nebulised, topical, oral |
| adsorption | 50% from GI tract; bioavailability 30-35% |
| target receptor | plasminogen |
| elimination | 95% excreted in kidnes; t1/2 2 hours |
| mechanism of action | competitive inhibitor of plasminogen activation by binding to 5-lysine site on plasminogen → inhibits formation of plasmin and displaces plasminogen from surface of fibrin. <br>prevents breakdown of fibrin, thus maintaining clot integrity<br>- also indirect effects via plasminogen inhibition on compliment activation → reduces consumption of C1 esterase → hence use in angioedema |
## contraindications
Adverse effects of the drug include intravascular thrombosis from inhibition of plasminogen activator, hypotension, myopathy, abdominal discomfort, diarrhea, and nasal stuffiness. The drug should not be used in patients with disseminated intravascular coagulation or genitourinary bleeding of the upper tract, eg, kidney and ureters, because of the potential for excessive clotting.
trauma > 3 hours