Successful Treatment of Mucosal Bleeding with Tranexamic Acid in Pediatric Patients with Hemostatic Disorders

Objects

Hemostatic disorders, including thrombocytopenia and/or coagulation disorders, sometimes cause mucosal bleeding and/or bleeding risks. In some cases, severe mucosal bleeds cannot be adequately controlled by standard therapy. Tranexamic acid (TA) is used in preventing and reducing bleeding in such medical settings. But there is little information on useful TA management of mucosal bleeding in hemostatic disorders.

Materials and Methods

4 patients with ITP, 2 hemophilia A patients and one VWD patient were treated with TA (1.5 - 3.0 g/day ) due to recognizable mucosal bleeding. 2 patients were under regular treatment for ITP. The remaining 2 patients with ITP did not require additional therapy. 2 hemophilia A patients were mild case and require on demand therapy of FVIII concentrates. VWD patient did not require any therapy with no mucosal bleeds.

Results

One of the ITP patients were suffering from frequent nasal bleeding and kept her away from school for 1.5 years. She had been going back to school without limitation of physical activity in spite of low PLT count. Remaining 3 patient of ITP who was suffering from frequent nasal bleeds had been managed with TA ( 1.5 g/day ). 2 hemophilia patients who were experienced oral mucosal bleed after tooth extraction were successfully managed with TA ( 1.5 g/day ). VWD patient who were suffering from frequent nasal bleed were ceased after initiation of TA.

Conclusions

Cessation or, at least significant improvement of bleeding was achieved shortly after initiation of TA in all cases. TA was well tolerated and discontinued after cessation of bleeding. We recommend the use of TA in hemostatic disorder patients with bleeding and/or an increased bleeding risk. Ultimately, cessation of bleeding plays a key role in the QOL improvement of such affected patients. However, future studies are required to optimize dose and administration routes (intravenous or oral).