Tranexamic acid and Eta-Aminocaproic acid

Tranexamic and eta-aminocaproic acid

Synthetic derivative of the amino acid LYSINE.

It is a PLASMIN INHIBITOR.

Plasmin interacts with fibrin by binding to lysine residues on fibrin. Tranexamic and eta-aminocaproic acid are competitive inhibitors of this binding. Of the two, Tranexamic acid is 10 times more potent. According to the CRASH-2 trial, it reduces all cause mortality in trauma patients. The trial-based dosing regimen was 1g within the first 3 hrs, followed by an infusion of 1g over the following 8 hours. A more detailed dissection of the CRASH-2 trial is performed in the chapter on haemostatic resuscitation.

Unfortunately, tranexamic acid tructuraly resembles GABA, but does nothing to excite its receptors. The consequence of this crossreactivity is seizures, although it appears one requires insanely large doses, in the order fo 7-10g.

References

For details of reversal of anticoagulation, I direct you all to the NHMRC guidelines:

Clinical practice guidelines on the use of blood components (2001)