From the FDA Drug Label
Tranexamic acid is contraindicated in patients with active intravascular clotting. Tranexamic acid is an antifibrinolytic and may increase the risk of thromboembolic events. Venous and arterial thrombosis or thromboembolism has been reported in patients treated with Tranexamic acid
The FDA drug label does not explicitly state that there is an absolute contraindication for using Tranexamic Acid (TXA) in patients with a history of Deep Vein Thrombosis (DVT). However, it does mention that TXA may increase the risk of thromboembolic events and is contraindicated in patients with active intravascular clotting.
- Key points:
From the Research
A history of deep vein thrombosis (DVT) is not an absolute contraindication for using Tranexamic Acid (TXA). However, caution is warranted as TXA is an antifibrinolytic agent that inhibits the breakdown of blood clots, which theoretically could increase thrombotic risk in patients with prior DVT. According to the most recent and highest quality study, 2, TXA utilization was not associated with an increased risk of postoperative pulmonary embolism, stroke, or myocardial infarction in patients with a history of venous thromboembolism.
Key Considerations
- TXA should be used with careful risk-benefit assessment in patients with a history of DVT.
- The medication is relatively contraindicated in patients with active thromboembolic disease, severe renal impairment, or a history of seizures.
- When TXA is deemed necessary in patients with prior DVT, consider using the lowest effective dose for the shortest duration possible.
- Standard dosing for acute hemorrhage is typically 1 gram IV over 10 minutes, followed by 1 gram over 8 hours, though protocols vary by indication.
- For patients with both bleeding risk and history of DVT, concurrent prophylactic anticoagulation might be considered depending on the clinical scenario.
Clinical Context
The decision to use TXA should be individualized based on the patient's current thrombotic risk, the severity of bleeding or bleeding risk, and the specific clinical context. As noted in 2, patients who received TXA demonstrated decreased risks of transfusion and 90-day readmission, suggesting that TXA may be safely utilized among select high-risk patients. The mechanism behind this recommendation is that while TXA inhibits fibrinolysis (clot breakdown), it does not directly promote new clot formation, making its use possible but cautious in patients with prior DVT.