Use of antifibrinolytic agents
How tranexamic acid works, where trials show it helps (trauma within 3 hours, postpartum haemorrhage, surgery, heavy menstrual bleeding, dental extraction) and where it doesn't (GI bleeding, thrombocytopenia, DIC, upper urinary tract bleeding).
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Tranexamic acid (TXA) is the antifibrinolytic used in Australia. It stops clots dissolving; it doesn't make clots form.
- It helps when fibrinolysis is driving bleeding: early trauma, postpartum haemorrhage, surgery, and mucosal bleeding in the mouth, nose and uterus.
- Timing matters. In trauma and postpartum haemorrhage the benefit is within 3 hours. Later doses don't help and may harm.
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Sources
- Patient Blood Management Guideline for Adults with Critical BleedingAU/NZNational Blood Authority, 2023, v2.0 2025
- Patient Blood Management Guidelines Module 2, PerioperativeAU/NZNational Blood Authority, 2012 (archived July 2026)
- Blood transfusion and reducing the need for transfusion in surgery (NG24)National Institute for Health and Care Excellence, 2015, tranexamic acid recommendations updated February 2026
- Therapeutic Guidelines (Haematology; Sexual and Reproductive Health, heavy menstrual bleeding)AU/NZTherapeutic Guidelines Ltd
- Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2)CRASH-2 trial collaborators, Lancet 2010;376:23-32, 2010
- Prehospital tranexamic acid for severe trauma (PATCH-Trauma)AU/NZPATCH-Trauma Investigators and ANZICS Clinical Trials Group, N Engl J Med 2023;389:127-36, 2023
- Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN)WOMAN Trial Collaborators, Lancet 2017;389:2105-16, 2017
- Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT)HALT-IT Trial Collaborators, Lancet 2020;395:1927-36, 2020
- Tranexamic acid in patients undergoing coronary-artery surgery (ATACAS)AU/NZMyles PS et al., N Engl J Med 2017;376:136-48, 2017
- Tranexamic acid in patients undergoing noncardiac surgery (POISE-3)Devereaux PJ et al., N Engl J Med 2022;386:1986-97, 2022
- Tranexamic acid versus placebo to prevent bleeding in patients with haematological malignancies and severe thrombocytopenia (TREATT)TREATT Trial Investigators, Lancet Haematol 2025;12:e14-22, 2025
- Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3)CRASH-3 trial collaborators, Lancet 2019;394:1713-23, 2019
- Last updated
- 14 November 2026
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