Tranexamic acid (TXA) is an antifibrinolytic agent first approved by the US Food and Drug Administration (FDA) in 1986. It is available as an intravenous (IV) solution and an oral tablet. The IV formulation is approved by the FDA for short-term use (2 to 8 days) to prevent bleeding in patients with hemophilia undergoing tooth extraction, and the oral formulation is approved for use in patients with cyclic heavy menstrual bleeding.1,2  Although it carries only these 2 labeled indications, TXA has been evaluated in many other clinical scenarios since its initial approval, resulting in a wide spectrum of off-label use in clinical practice.

Tranexamic acid works by inhibiting fibrinolysis. In the normal process of fibrinolysis, tissue plasminogen activator binds to plasminogen to activate it to plasmin. Plasmin then binds to the fibrin in blood clots, ultimately resulting in the breakdown of the clot. Tranexamic acid binds reversibly...

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