Can tarmic cause hematuria (blood in urine)?

Tarmic Does Not Directly Cause Hematuria

Tarmic (tranexamic acid) is not listed as a medication that directly causes hematuria in any of the available evidence. While many medications can cause hematuria, the most recent and comprehensive pharmacovigilance data from 2024 identifies rivaroxaban, warfarin, aspirin, clopidogrel, dabigatran, apixaban, cyclophosphamide, lansoprazole, enoxaparin, and ibuprofen as the medications most commonly associated with hematuria 1. Tranexamic acid (Tarmic) is notably absent from this list.

Medications Associated with Hematuria

According to the 2024 analysis of the FDA Adverse Event Reporting System and EudraVigilance databases:

• Anticoagulants and antiplatelets are the medication classes most frequently associated with hematuria 1
• Rivaroxaban and warfarin appear to be the most strongly associated with hematuria (PRR>1, P<0.05) 1
• Apixaban was identified as the safest anticoagulant in terms of hematuria risk (PRR<1, P<0.05) 1
• Cyclophosphamide (7.2%), enoxaparin (3%), and dabigatran (2.5%) had the highest rates of fatal hematuria episodes 1

Common Causes of Hematuria

The American College of Radiology and American Urological Association guidelines identify several common causes of hematuria:

• Urinary tract infections
• Urolithiasis (kidney stones)
• Benign prostatic hyperplasia
• Urinary tract malignancy
• Glomerular diseases
• Trauma (including sports-related trauma)
• Medications (particularly anticoagulants and antiplatelets) 2, 3

Evaluation of Hematuria

If a patient presents with hematuria while taking tranexamic acid, consider:

1. Ruling out common causes: Urinary tract infection, stones, BPH, or malignancy 3, 4
2. Medication review: Check for concomitant medications that are known to cause hematuria, particularly anticoagulants or antiplatelets 5, 1
3. Risk stratification: The American Urological Association recommends stratifying patients into low, intermediate, and high risk for cancer based on factors such as RBC count, age, and smoking history 3

Sports-Related Hematuria

If the patient engages in strenuous physical activity, consider exercise-induced hematuria:

• Strenuous exercise can cause microscopic hematuria in up to 95% of cases 6, 7
• The intensity of exercise correlates with the degree of hematuria 7
• Contact sports increase the risk of macroscopic hematuria 7
• Mechanisms include:
  • Renal vasoconstriction during exercise causing hypoxic damage to nephrons
  • Increased glomerular filtration pressure
  • Direct trauma to the urinary tract 6, 7

Management Recommendations

If a patient on tranexamic acid develops hematuria:

1. Complete urinalysis to confirm true hematuria (≥3 RBCs/HPF) 3
2. Laboratory workup: CBC, serum creatinine, BUN, and urine culture if infection is suspected 3
3. Imaging: CT urography for patients with gross hematuria (sensitivity 92%, specificity 93%) 3
4. Urologic referral: Immediate referral for all patients with gross hematuria 3
5. Review medications: Consider other medications the patient may be taking that are more likely to cause hematuria 5, 1

Key Points

• Tranexamic acid is not among the medications commonly associated with hematuria
• If hematuria occurs in a patient taking tranexamic acid, investigate other common causes
• Anticoagulants and antiplatelets are the medication classes most strongly associated with hematuria
• All cases of gross hematuria warrant thorough evaluation regardless of medication use