Contraindications to Tranexamic Acid in Menorrhagia

Major Contraindications

• The primary contraindication to tranexamic acid in menorrhagia is a known thromboembolic event during pregnancy or history of thrombosis, as TXA's antifibrinolytic properties may increase thrombosis risk in susceptible individuals 1, 2
• Known thromboembolic disease or history of thrombosis - TXA should be avoided in women with active thromboembolic disease or with a history or intrinsic risk for thrombosis or thromboembolism 1
• Beyond 3 hours after onset of bleeding in acute settings - While this applies more to postpartum hemorrhage than menorrhagia, TXA administration beyond 3 hours after onset of acute bleeding may be potentially harmful 2, 3

Thrombotic Risk Considerations

• Documented increased rates of thrombosis with high-dose TXA - High-dose IV TXA (4g/24h or greater) has been associated with increased rates of:

Common Side Effects (Not Contraindications)

• Seizures - An increased rate of seizures has been reported with high-dose TXA use 4, 5

Clinical Decision-Making

• When considering TXA for menorrhagia, physicians should screen for history of thromboembolism or risk factors for thrombosis 5
• Physicians should monitor for signs of thrombotic complications during treatment 5