From the Guidelines
Tranexamic acid (TXA) should not be used as a first-line treatment for hereditary angioedema (HAE) due to limited evidence supporting its efficacy and potential to prolong attacks 1.
Current Recommendations
The current guidelines recommend that every patient should be evaluated for long-term prophylaxis, and highly effective new agents like subcutaneous C1-INH and lanadelumab should become first-line prophylactic treatments 1.
TXA Use
TXA can be considered for mild attacks, such as peripheral edema and less severe abdominal attacks, at a dose of 1000 mg every 3-4 h for 12-18 h 1.
Key Considerations
However, it is essential to note that TXA may prolong the attack, and its use should be cautious, especially in patients with thromboembolic risk factors 1.
Alternative Treatments
Newer treatments like C1 inhibitors, icatibant, and lanadelumab are preferred for HAE, but TXA may remain valuable for patients without access to these medications or for those with non-histaminergic angioedema unresponsive to antihistamines 1.
Key Points to Consider
- TXA is not recommended for long-term prophylaxis due to lack of scientific evidence supporting its efficacy 1
- TXA may be considered for mild attacks, but its use should be cautious 1
- Newer treatments are preferred for HAE, but TXA may remain valuable for patients without access to these medications 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Evidence for TXA in Angioedema
- Tranexamic acid (TXA) is an antifibrinolytic agent that inhibits the conversion of plasminogen to plasmin, a key step in kallikrein activation and bradykinin formation 2.
- TXA has been used in the prophylactic management of hereditary angioedema, and there is limited evidence for its use in angiotensin converting enzyme (ACE) inhibitor-induced angioedema (ACEI-AE) 2, 3.
- A case study reported a patient with ACEI-AE who was successfully treated with TXA, suggesting that TXA may be a beneficial treatment modality in the management of ACEI-AE 2.
- A retrospective observational study found that TXA reduced the number of attacks by 75% in 17 patients with non-histaminergic angioedema, and was well tolerated with no thromboembolic events 4.
Efficacy of TXA in Acquired Angioedema
- A longitudinal study reported that TXA was effective as prophylaxis for angioedema attacks in patients with acquired angioedema, with a decrease in attacks by 97,86, and 99% at 1,12, and 24 months, respectively 5.
- However, one patient developed a deep vein thrombosis and TXA was stopped, highlighting the need for caution and monitoring for potential adverse effects 5.
TXA in ACE Inhibitor-Induced Angioedema
- A retrospective cohort study found that TXA use was not associated with improved clinical outcomes in patients with ACEI-AE, and may be associated with more severe disease 6.
- However, other studies have reported successful treatment of ACEI-AE with TXA, suggesting that it may be a safe and effective treatment option 2, 3.