What are the key counseling points for tranexamic acid (Nonsteroidal Anti-Fibrinolytic Agent) when used for abnormal uterine bleeding?

Key Counseling Points for Tranexamic Acid in Abnormal Uterine Bleeding

Tranexamic acid is an effective first-line treatment for abnormal uterine bleeding that reduces menstrual blood loss by 26-60% and significantly improves quality of life for women with this condition. 1

Mechanism and Efficacy

• Tranexamic acid is a non-hormonal antifibrinolytic agent that works by inhibiting fibrin degradation, thereby reducing bleeding
• More effective than placebo, NSAIDs, oral cyclical luteal phase progestins, and oral etamsylate 1
• Provides rapid control of bleeding, with significant improvement often seen within the first week of treatment 2

Dosage and Administration

• Recommended oral dosage: 3.9-4 g/day (divided into 3-4 doses) for 4-5 days starting from the first day of the menstrual cycle 1
• For acute management of postpartum hemorrhage: 1 g IV over 10 minutes, with a second dose if bleeding continues after 30 minutes or restarts within 24 hours 3
• Treatment should be limited to the days of heavy bleeding only

Safety Profile and Contraindications

• Generally well-tolerated with few and mainly mild adverse effects 1
• Absolute contraindications:
  • Active thromboembolic disease
  • History of thrombosis or thromboembolism (in US labeling)
  • Intrinsic risk for thrombosis or thromboembolism 4
• Use with caution in:
  • Patients with renal impairment (dose adjustment required) 4
  • Patients with history of seizures
  • Patients with cardiovascular disease

Drug Interactions

• Combined use with hormonal contraceptives may increase risk for thromboembolic events 4
• Advise patients using hormonal contraception to use effective alternative (non-hormonal) contraception during therapy with tranexamic acid 4

Potential Side Effects to Discuss

1. Common side effects:

   • Nausea, vomiting
   • Diarrhea
   • Headache
   • Dizziness

2. Serious but rare side effects requiring immediate medical attention:

   • Signs of thrombosis (leg pain/swelling, chest pain, shortness of breath)
   • Visual disturbances (requires ophthalmologic evaluation) 4
   • Seizures (particularly with higher doses) 5
   • Hypersensitivity reactions 4

Patient Education Points

• Explain that tranexamic acid is not a contraceptive
• Advise patients to take medication only during menstrual bleeding days
• Instruct patients to report any unusual symptoms promptly
• Inform patients that tranexamic acid may cause dizziness and caution about driving or operating machinery 4
• Reassure patients that when used as directed, there is no evidence of increased thrombotic events in most patients 1
• Emphasize the importance of adhering to the prescribed dosage and duration

Follow-up Recommendations

• Schedule follow-up after 3 months to assess efficacy and side effects
• Monitor hemoglobin levels if anemia was present at baseline
• Consider alternative treatments if inadequate response after 3 cycles
• Discuss long-term management options if treatment is effective

Special Considerations

• For patients with spontaneous coronary artery dissection (SCAD), tranexamic acid may be one of the few options available for managing abnormal uterine bleeding, as hormonal treatments are relatively contraindicated 3
• In patients with renal impairment, dose adjustment is needed as blood levels of tranexamic acid increase with decreased renal function 4

By providing comprehensive counseling on these points, healthcare providers can help patients make informed decisions about using tranexamic acid for abnormal uterine bleeding while minimizing risks and maximizing benefits.