From the Guidelines
Tranexamic acid (TXA) is not currently recommended as a first-line treatment for angioedema, and its use should be limited to specific cases where other treatments are unavailable or ineffective, due to its potential to prolong attacks and modest efficacy in prophylaxis 1.
Introduction to Angioedema and TXA
Angioedema is a condition characterized by rapid swelling of the skin and mucous membranes, which can be life-threatening if not properly managed. Tranexamic acid (TXA) has been explored as a potential treatment for angioedema, particularly in the context of hereditary angioedema (HAE). However, its role in acute angioedema management remains limited, and it is not considered a first-line treatment.
Current Recommendations for Angioedema Treatment
For acute HAE attacks, first-line treatments include:
- C1 esterase inhibitor concentrates (Berinert, Cinryze)
- Icatibant (Firazyr)
- Ecallantide (Kalbitor) These treatments have been shown to be safe and efficacious for the treatment of acute HAE attacks, and are preferred over TXA due to their targeted mechanism of action and established efficacy 1.
Role of TXA in Angioedema Prophylaxis
TXA may be considered for prophylaxis of HAE at doses of 1000-1500 mg orally two to three times daily, but its efficacy is modest compared to other available treatments such as lanadelumab (Takhzyro), berotralstat (Orladeyo), or C1 inhibitor concentrates 1. TXA works by inhibiting plasminogen activation, which indirectly reduces bradykinin production—a key mediator in angioedema.
Safety Profile of TXA
The safety profile of TXA includes potential thromboembolic risks, making benefit-risk assessment essential, particularly in patients with cardiovascular disease or thrombosis history 1. When considering TXA for HAE prophylaxis, it is essential to monitor for side effects including nausea, diarrhea, and hypotension, and ensure patients understand its limitations compared to more effective targeted therapies.
Non-Hereditary Forms of Angioedema
For non-hereditary forms of angioedema (histamine-mediated), standard treatment includes antihistamines, corticosteroids, and epinephrine for severe cases, with no established role for TXA 1. The management of these cases should focus on addressing the underlying cause of the angioedema and providing supportive care as needed.
Key Takeaways
- TXA is not a first-line treatment for angioedema
- First-line treatments for acute HAE attacks include C1 esterase inhibitor concentrates, icatibant, and ecallantide
- TXA may be considered for prophylaxis of HAE, but its efficacy is modest and it should be used with caution due to potential thromboembolic risks
- Patients should be closely monitored for side effects and understand the limitations of TXA compared to more effective targeted therapies 1.
From the Research
InPHARMation Newsletter: Appropriate Use of TXA in Angioedema
- Angioedema is a self-limiting edema of the subcutaneous or submucosal tissues due to localized increase of microvascular permeability whose mediator may be histamine or bradykinin 2.
- The treatment of angioedema depends on the underlying cause, with allergic histaminergic angioedema being sensitive to standard therapies such as epinephrine, glucocorticoids, and antihistamines, whereas non-histaminergic angioedema is often resistant to these drugs 2.
- Tranexamic acid (TXA) has been shown to be a successful treatment option for idiopathic angioedema, with 154 patients responding to treatment 3.
- TXA is a kallikrein inhibitor that can be used to treat hereditary angioedema, and its use in idiopathic angioedema suggests that it may be a viable option for patients with this condition 3.
- However, the use of TXA in angioedema is not universally recommended, and more clinical trials are needed to fully understand its efficacy and safety in this population 3.
- In the case of ACE inhibitor-induced angioedema, the discontinuation of the causative drug is recommended, and TXA may be considered as a treatment option, although its use is not currently recommended as a first-line treatment 2, 4.
- The diagnosis of angioedema is primarily clinical, with laboratory tests used to confirm the diagnosis, and the treatment should be tailored to the underlying cause of the condition 2, 5, 6.