What is the role of tranexamic acid in the treatment of hyphema?

Updated: Jan 18, 2019
  • Author: David L Nash, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
  • Print


Although also unapproved for ophthalmic use in the United States, another lysine analog, tranexamic acid, also has antifibrinolytic properties. In a series of children treated with tranexamic acid (25 mg/kg/d), the incidence of secondary hemorrhage was significantly reduced. [50] Like ACA, tranexamic acid has been associated with nausea, vomiting, and hypotension. Unlike ACA, tranexamic acid is associated with visual abnormalities, which could complicate the ophthalmologic evaluation of the patient. In addition, some patients in this study were treated with other drugs, including topical steroids. One study found that tranexamic acid was better than oral steroids in preventing rebleeding rates. [51] A meta-analysis of hyphema literature determined antifibrinolytics had a significant impact on hyphema rebleeding. [52] The authors suggested antifibrinolytics use in patients at high risk for associated hyphema complications.

A 2013 Cochrane review concluded that the antifibrinolytics ACA (both topical and systemic), tranexamic acid, and aminomethylbenzoic acid all reduced the rate of secondary hemorrhage. [35] Until a commercial option becomes readily available, topical ACA can be ordered through Leiter's Pharmacy.

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!