Contents:
Risk assessment
Multidisciplinary team working is needed, to balance risk vs harm. This assessment should include a discussion with the patient and family where possible.
Contra-indications:
- History of thrombo-embolism
- Known previous reaction to antifibrinolytic drugs
- History of convulsions (mainly with IV use)
- Disseminated intravascular coagulation (DIC)
Cautions
- History of thrombo-embolism
- Severe renal impairment – see further information below
Harm reduction
- If risks are present, multidisciplinary discussions should take place to weigh up the risk vs benefit
- Consideration of alternative treatments such as cauterisation, embolization, radiotherapy
- Review and stop any anticoagulants and antiplatelet medication and other drugs which may increase bleeding risk, including nonsteroidal anti-inflammatory drugs (NSAIDs) and SSRIs
- Risk vs benefit to be discussed where appropriate with patient and family
Renal impairment
Tranexamic acid is mainly excreted unchanged by the kidneys, therefore dose reduction is necessary in renal impairment.
The following guidance can be used (Palliative Care Formulary 7th edition page 112)
Plasma creatinine (micromol/lit)
120-249
250-500
>500
eGFR (ml/min)
50-80
10-50
<10
PO dose
15 mg/kg BD
15 mg/kg once daily
7.5 mg/kg once daily OR 15mg/kg every 2 days
IV dose
10mg/kg bd
10mg/kg once daily
5mg/kg once daily OR 10mg/kg every 2 days
CSCI doses need to be similarly adjusted in renal impairment
Side effects
(see BNF/ PCF for further information)
Common or very common
Diarrhoea (reduce dose); nausea; vomiting
Uncommon
Allergic dermatitis
Rare or very rare
Colour vision change (discontinue); embolism and thrombosis
Frequency not known
Seizure (more common at high IV doses); visual impairment (discontinue)
Disclaimer
These Guidelines are intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
Whilst SPAGG takes every care to compile accurate information , we cannot guarantee its correctness and completeness, and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.