Hematology: Antifibrinolytic Medications

Tranexamic Acid (TXA)

• Mechanism: Inhibits Plasminogen Conversion to Plasmin
  • Thereby Inhibits Fibrinolysis & Clot Breakdown
  • Higher Affinity (6-10x) for Binding Plasminogen than ε-Aminocaproic Acid
• Used More Commonly in the U.S. than ε-Aminocaproic Acid
• Potential Indications:
  • Trauma & Hemorrhagic Shock
    • *See Hemorrhagic Shock & Trauma Resuscitation
  • Bleeding Due to Hyperfibrinolysis
  • Postpartum Hemorrhage
  • Surgical Blood Loss
  • Intracranial Hemorrhage (ICH) – SAH/SDH
  • GI Bleeding
  • Thrombolytic Overdose

ε-Aminocaproic Acid (Amicar/EACA)

• Mechanism: Inhibits Plasminogen Conversion to Plasmin
  • Thereby Inhibits Fibrinolysis & Clot Breakdown
  • Lower Affinity for Binding Plasminogen than TXA
• Used Less Frequently in the U.S. than TXA
• Use:
  • Bleeding Due to Hyperfibrinolysis
  • Thrombolytic Overdose
  • Rebleeding After Recent Intracranial Hemorrhage (ICH)
  • Surgical Blood Loss