A Lesser-Known Indication for Tranexamic Acid

This post will be a short one.

I love Tranexamic Acid aka TXA (Cyclokapron in Canada/USA and sometimes as Lysteda in USA as its oral formulation). The CRASH-2 trial showed that, when given to trauma patients with significant bleeding, TXA saves lives – the earlier the better (ie first three hours is best). Its role in treating heavy menstrual bleeding has also been established – outperforming NSAIDs and hormal therapies. I won’t go into details for either of these indications. References are available below. Overall the drug appears very effective and has a good safety profile to boot.

I have found a new indication for this wonder drug…

I had a patient the other day on anticoagulants for thromboprophylaxis because of prosthetique heart valves. He came to the ED complaining of bleeding from the site of a dental extraction a few days prior. Clamping on gauze didn’t help. Plan B was surgifoam. However I called our on-call hematologist to get their opinion and they suggested Tranexemic Acid 4.8% mouthwash… I had never used this, but it sounded familiar for treatment of hemophiliacs. I called our pharmacy and indeed this was available (oral tabs dissolved in solution) – indicated for patients on anticoagulants or inherited disorders of hemostasis undergoing oral procedures.

I looked it up – this 1989 NEJM trial  randomized 39 patients on anticoagulation undergoing oral surgery to either 4.8% TXA or placebo. In a nutshell, those who had the surgical field rinsed with TXA and then had 7 days of QID rinses had 1 post-op bleeding episode versus 10 episodes in the placebo group. Impressive. Currently, the standard is a regimen consisting of QID rinse of 2 minutes duration for 2 days, which has been shown to be as effective as regimens of longer duration.

I love Tranexamic Acid. Although this comic strip on TXA is very strange.If that link didn’t work, try this one: https://docs.google.com/viewer?url=http://blogs.lshtm.ac.uk/news/files/2012/09/TXA.pdf&hl=en_US&embedded=true .

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