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INTRODUCTION

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tranexamic acid (tran-eks-am-ik as-id)

Cyklokapron

Classification

Therapeutic: hemostatic agents

Pharmacologic: antifibrinolytics, plasminogen inactivators

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Indications
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Prevention or reduction of hemorrhage following dental surgery in hemophiliacs.

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Action
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Inhibits activation of plasminogen, thereby preventing the conversion of plasminogen to plasmin. Therapeutic Effects: ↓ bleeding following dental surgery in hemophiliacs. Reduced need for replacement therapy.

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Adverse Reactions/Side Effects
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CNS: dizziness. EENT: visual abnormalities. CV: hypotension, thromboembolism, thrombosis. GI: diarrhea, nausea, vomiting.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for bleeding gums, nosebleeds, or other unusual bleeding or bruising that might indicate inadequate drug effects. Report signs of bleeding to the physician immediately.

  • Monitor increased blood coagulation, including venous thrombosis (lower extremity swelling, warmth, erythema, tenderness) or arterial thrombosis (extreme coldness in the hands and feet, cyanosis, muscle cramping). Watch for pulmonary embolism (shortness of breath, chest pain, cough, bloody sputum) or arterial thrombosis that could lead to MI or stroke. Notify physician immediately, and request objective tests (Doppler ultrasound, others) if thrombosis is suspected.

  • Assess blood pressure and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient develops dizziness or syncope.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

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Patient/Client-Related Instruction
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  • Instruct patient to report other troublesome side effects such as severe or prolonged vision abnormalities or GI problems (nausea, vomiting, diarrhea).

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Pharmacokinetics
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Absorption: 30–50% absorbed following oral administration.

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Distribution: Penetrates readily into joint fluid and synovial membranes.

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Metabolism and Excretion: 95% excreted unchanged in urine.

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Half-life: 2 hr (↑ in renal impairment); 3 hr in joint fluid.

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TIME/ACTION PROFILE (blood levels)

ROUTE ONSET PEAK DURATION
PO unknown 3 hr 7–8 hr*
IV unknown unknown 7–8 hr

*Antifibrinolytic concentration in plasma; tissue levels persist for 17 hr.

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Active intravascular clotting; Acquired defective color vision; Subarachnoid hemorrhage.

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Use Cautiously in: Renal impairment (↑ dosing interval is recommended if serum creatinine >1.36 mg/dL); Hematuria originating in the upper urinary tract; Conditions associated with ↑ thrombus formation; Pregnancy or lactation (safety not established).

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Interactions
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Drug-Drug: Concurrent use of clotting factor complexes may ↑ the risk of thrombotic complications (give tranexamic acid 8 hr following clotting factor replacement therapy).

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Route/Dosage
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PO (Adults and Children): 25 mg/kg tid–qid, beginning the day before ...

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