From the Guidelines
Tranexamic acid is contraindicated in patients with subarachnoid hemorrhage, active thromboembolic disease, and those with a history of thromboembolism or known thrombophilia, as well as in patients with cirrhosis and active variceal bleeding, due to the increased risk of thrombotic events and cerebral ischemia.
Conditions to Avoid Tranexamic Acid
- Subarachnoid hemorrhage: as it may increase the risk of cerebral ischemia in these patients 1
- Active thromboembolic disease: such as deep vein thrombosis, pulmonary embolism, or arterial thrombosis, as it may exacerbate clotting
- History of thromboembolism or known thrombophilia: as these conditions have relative contraindications
- Cirrhosis and active variceal bleeding: as tranexamic acid may increase the risk of thrombotic events, particularly venous thromboembolic events, as shown in a large randomized placebo-controlled trial 1
Special Considerations
- Severe renal impairment: requires dose adjustment or avoidance due to drug accumulation 1
- Active intravascular clotting conditions: like disseminated intravascular coagulation (DIC) generally contraindicate tranexamic acid unless there is predominant fibrinolysis
- Hematuria of upper urinary tract origin: is a contraindication as clots may cause urinary obstruction
- Seizure disorders: caution is warranted as tranexamic acid may lower seizure threshold
- Pregnancy and cardiovascular disease: the medication should be used cautiously in these patients, although it is not absolutely contraindicated 1
From the FDA Drug Label
Tranexamic acid Injection is contraindicated: • In patients with subarachnoid hemorrhage Anecdotal experience indicates that cerebral edema and cerebral infarction may be caused by Tranexamic acid in such patients. • In patients with active intravascular clotting [see Warnings and Precautions (5.1)]. • In patients with hypersensitivity to tranexamic acid or any of the ingredients [see Warnings and Precautions (5.4)].
The contraindications to tranexamic acid are:
- Subarachnoid hemorrhage: due to the risk of cerebral edema and cerebral infarction.
- Active intravascular clotting: as tranexamic acid may increase the risk of thromboembolic events.
- Hypersensitivity to tranexamic acid or any of the ingredients: due to the risk of hypersensitivity reactions, including anaphylactic reactions 2.
From the Research
Contraindications to Tranexamic Acid
- The use of tranexamic acid (TXA) is generally considered safe, but there are some potential contraindications to consider:
- History of venous thromboembolism: While some studies suggest that TXA may not increase the risk of thromboembolic events in patients with a history of venous thromboembolism 3, others have found an association between oral TXA use and venous thromboembolism in women 4.
- Arterial thrombosis: There is limited evidence to suggest that TXA increases the risk of arterial thrombosis, such as stroke or myocardial infarction 5, 6.
- Trauma patients: One study found that TXA administration was not significantly associated with venous thromboembolism (VTE) in trauma patients, but the risk of VTE among trauma patients receiving TXA remains high 7.
Special Considerations
- Patients with a history of thromboembolism: TXA may be safely utilized among select high-risk patients, but the decision to use TXA should be made on a case-by-case basis 3.
- Women of childbearing age: Oral TXA use has been associated with an increased risk of venous thromboembolism in women, particularly those with other risk factors for thrombosis 4.
- Trauma patients: The use of TXA in trauma patients should be carefully considered, and early initiation of DVT prophylaxis may be necessary to reduce the risk of VTE 7.