Please click to visit San Ramon Regional Medical Center

NoBlood Answers

ASK questions regarding Transfusion Alternatives and Patient Blood Management.

SHARE your facts, opinions and personal experience.

DISCOVER the best answers chosen by Healthcare Professionals and the Public.

RANK the best answers.

199 questions

265 answers

78 comments

75 users

Popular Tags

treatmentsx 54  conditionsx 36  pharmaceuticalsx 19  transfusionsx 19  bloodx 18  anemiax 16  alternativesx 13  epox 13  devicesx 10  managementx 10  documentsx 9  dpax 8  legalx 8  fractionsx 7  ironx 7  plateletsx 7  techniquesx 7  cancerx 6  coagulationx 6  dphcx 6  hospitalsx 6  outcomesx 6  preparationx 6  surgeryx 6  toolsx 6  cardiacx 5  cell-salvagex 5  dietx 5  hemodilutionx 5  leukemiax 5  programsx 5  vaccinesx 5  diagnosisx 4  hbocx 4  plasmax 4  proteinx 4  testingx 4  transplantsx 4  volume-expandersx 4  bloodlessx 3  esax 3  fibrin-gluex 3  financialx 3  formsx 3  guidelinesx 3  hemoglobinx 3  hemorrhagex 3  hemostasisx 3  hepatitis-cx 3  immunoglobulinx 3  lungx 3  oxygenx 3  pregnancyx 3  surgicalx 3  syntheticx 3  acidx 2  adhesivesx 2  amlx 2  bleedingx 2  carriersx 2  chemotherapyx 2  chlorophyllx 2  cllx 2  cmmlx 2  creutzfeldt-jakobx 2  diptheriax 2  diseasesx 2  doctorsx 2  factor-7x 2  heartx 2  jcahox 2  liverx 2  pediatricx 2  preemiex 2  proceduresx 2  procritx 2  rbcx 2  sickle-cellx 2  studiesx 2  surgeonsx 2  tetanusx 2  thalassemia-majorx 2  tranexamicx 2  transmissionx 2 

More Tags

What is the role of Tranexamic acid in the treatment of heavy menstrual bleeding (Menorrhagia )?

0 like 0 dislike
asked Jun 25, 2012 in Conditions and Treatments by Hatice Simsek MD (3,070 points)
edited Jul 2, 2012 by Jan B. Wade

5 Answers

2 like 0 dislike
Obstet Gynecol. 2010 Oct;116(4):865-75.

Tranexamic acid treatment for heavy menstrual bleeding: a randomized controlled trial.

Source

Carolina Women's Research and Wellness Center, Durham, North Carolina 27713, USA. andrealukes@cwrwc.com

Abstract

OBJECTIVE:

To assess the efficacy and safety of an oral formulation of tranexamic acid for the treatment of heavy menstrual bleeding.

METHODS:

Adult women with heavy menstrual bleeding (mean menstrual blood loss 80 mL or more per cycle) were enrolled in a double-blind, placebo-controlled study. After two pretreatment menstrual cycles, women were randomized to receive tranexamic acid 3.9 g/d or placebo for up to 5 days per menstrual cycle through six cycles. To meet the prespecified three-component primary efficacy end point, mean reduction in menstrual blood loss from baseline with tranexamic acid treatment needed to be 1) significantly greater than placebo, 2) greater than 50 mL, and 3) greater than a predetermined meaningful threshold (36 mL or higher). Health-related quality of life was measured using a validated patient-reported outcome instrument.

RESULTS:

Women who received tranexamic acid (n=115) met all three primary efficacy end points: first, a significantly greater reduction in menstrual blood loss of -69.6 mL (40.4%) compared with -12.6 mL (8.2%) in the 72 women who received placebo (P<.001); reduction of menstrual blood loss exceeding a prespecified 50 mL; and last, reduction of menstrual blood loss considered meaningful to women. Compared with women receiving placebo, women treated with tranexamic acid experienced significant improvements in limitations in social or leisure and physical activities, work inside and outside the home, and self-perceived menstrual blood loss (P<.01). The majority of adverse events were mild to moderate in severity, and the incidence of gastrointestinal adverse events was comparable with placebo.

CONCLUSION:

In this study, a new oral tranexamic acid treatment was well tolerated and significantly improved both menstrual blood loss and health-related quality of life in women with heavy menstrual bleeding.

 

answered Jun 26, 2012 by Informaticus (470 points)
1 like 0 dislike

 

Expert Opin Pharmacother. 2011 Sep;12(13):2089-95. Epub 2011 Jul 18.

Tranexamic acid therapy for heavy menstrual bleeding.

Source

College of Medicine, Veterinary Medicine & Life Sciences, Glasgow Royal Infirmary, Glasgow, UK. Maryann.Lumsden@gla.ac.uk

Abstract

INTRODUCTION: Heavy menstrual bleeding (HMB, also known as menorrhagia) is an important health problem that interferes with women's quality of life. It is one of the most common reasons why women are seen by their family doctors in primary care and is a condition frequently treated by surgery. AREAS COVERED: This review covers the pharmacology oftranexamic acid in brief and concentrates on its use in the treatment of HMB. Papers published in the English language between January 1985 and November 2010 were reviewed using Medline, Embase, Cinahl and the Cochrane Database of Systematic Reviews. Search terms were 'heavy menstrual bleeding', 'tranexamic acid' and 'menorrhagia'. EXPERT OPINION:Tranexamic acid, a competitive inhibitor of plasminogen activation, has been used to treat HMB for well over four decades. Although several treatment options are available for HMB, tranexamic acid is particularly useful in women who either desire immediate pregnancy or for whom hormonal treatment is inappropriate. Tranexamic acid is a well-tolerated, cost-effective drug that reduces menstrual blood loss in the range of 34-59%. It improves the health-related quality of life in women in HMB.

PMID:
 
21767224
 
[PubMed - indexed for MEDLINE]

 

answered Jun 26, 2012 by Hatice Simsek MD (3,070 points)
1 like 0 dislike

 

 

Acta Obstet Gynecol Scand. 2012 May;91(5):529-37. doi: 10.1111/j.1600-0412.2012.01361.x. Epub 2012 Feb 24.

Efficacy of tranexamic acid in the treatment of idiopathic and non-functional heavy menstrual bleeding: a systematic review.

Naoulou BTsai MC.

Abstract

OBJECTIVE:

To evaluate the efficacy of tranexamic acid in the treatment of idiopathic and non-functional heavy menstrual bleeding.

DESIGN:

Systematic review.

POPULATION:

Women with a diagnosis of idiopathic and non-functional heavy menstrual bleeding treated with tranexamic acid.

METHODS:

Electronic searches were conducted in literature databases up to February 2011 by two independent reviewers. We included all trials involving the efficacy of tranexamic acid for the treatment of heavy uterine bleeding. Pregnant, postmenopausal and cancer patients were excluded.

MAIN OUTCOME MEASURES:

Effect of tranexamic acid treatment on objective reduction of menstrual bleeding and improvement in patient quality of life.

RESULTS:

A total of 10 studies met our inclusion criteria. Available evidence indicates that tranexamic acid therapy in women with idiopathic menorrhagia resulted in 34-54% reduction in menstrual blood loss. Following tranexamic acidtreatment, patient's quality-of-life parameters improved by 46-83%, compared with 15-45% for norethisterone treatment. When compared with placebo, tranexamic acid use significantly decreased the blood loss by 70% in women withmenorrhagia secondary to an intrauterine device (p<0.001). Limited evidence indicated potential benefit in fibroid patients withmenorrhagia. No thromboembolic event was reported in all studies analyzed.

CONCLUSIONS:

Available evidence indicates that tranexamic acid treatment is effective and safe, and could potentially improve quality of life of patients presenting with idiopathic and non-functional heavy menstrual bleeding. Data on the therapeutic efficacy of tranexamic acid in patients with symptomatic fibroids are limited, and further studies are therefore needed.

answered Jun 26, 2012 by Hatice Simsek MD (3,070 points)
1 like 0 dislike

 

J Womens Health (Larchmt). 2012 Mar 19. [Epub ahead of print]

Tranexamic Acid Increases Hemoglobin and Ferritin Levels in Women with Heavy Menstrual Bleeding.

Muse KMabey RGWaldbaum AGersten JKAdomako TL.

Abstract

Abstract Background: Heavy menstrual bleeding (HMB) is the most common cause of iron deficiency anemia (IDA) inwomen. A novel, modified-release oral formulation of tranexamic acid (TA) designed to reduce gastrointestinal side effects was approved recently for treatment of HMB. We assessed improvements in objective laboratory measures of IDA in womenwith self-reported HMB who received long-term TA therapy. Methods: Women enrolled in a long-term, open-label, multicenter study self-medicated with TA 3.9 g/day administered as 1.3 g orally up to three times daily for 5 days/menstrual cycle for 27 cycles. Oral iron therapy was required if serum hemoglobin (Hgb) levels decreased to <11 g/dL. Results: A total of 723women (mean age 38.3 years) were included in the intent-to-treat (ITT) population. Significant increases in mean serum Hgb and ferritin were observed throughout the study (p<0.01). Among 191 patients with low Hgb (<12 g/dL) at baseline, mean serum Hgb increased by ≥0.71 g/dL after the third cycle and all subsequent assessments (p<0.001). After 3 and 27 cycles, 34.1% and 45.7%, respectively, of patients with low Hgb at baseline shifted to within normal range, respectively. Among 233 patients with low ferritin (<10 ng/mL) at baseline, mean serum ferritin increased by >5.38 ng/mL after cycles 15 and 27. After 6 and 27 cycles, 35.2% and 58% of patients, respectively, with low ferritin levels at baseline shifted to within normal range. Conclusions: Long-term self-medication with this novel TA formulation improved Hgb and ferritin levels in women with self-reported HMB.

answered Jun 26, 2012 by Hatice Simsek MD (3,070 points)
1 like 0 dislike

Transexamica acid is a synthetic derivative of the amino acid lysine.  It's used to treat or prevent excessive blood loss in surgeries.  It is an antifibrinolytic that competitively inhibits the activation of plasminogen to plasmin, by binding to specific sites of both plasminogen and plasmin, a molecule responsible for the degradation of fibrin.  Fibrin is a protein that forms the framework of blood clots.
 

Mentrual bleeding stops when tiny clots seal blood vessels in the lining of the uterus.  In addition to materials that forms clots, there are compoinds in menstrual blood (plasmin) that dissolve these clots.  When they dissolve too quickly, excess bleeding occurs.  Tranexamic acid (brand name Lysteda) works by interfering with plasmin production, so the tiny clots needed to stop bleeding do not dissolve too quickly.  While Lysteda has been available in an oral form for over 20 years, it has only been available for use as a treament for heavy menstrual bleeding in the U.S. for a couple of years. 
 

In clinical trials, measured blood loss decreased by an average of 40% in women taking Lysteda and 8% in women taking the placebo.  One concern with this type of medication is the possibility of blood clots (DVT) forming in other blood vessels in the body, but there were no cases of DVT in the women taking Lysteda. 
 

answered Jul 7, 2012 by Leslie Richards RN (160 points)
edited Jul 7, 2012 by Jan B. Wade

Related questions

0
votes
1
answer
437
views
0
votes
4
answers
6733
views
0
votes
1
answer
156
views

Featured Sponsors