Overview
Lysine analog that inhibits plasminogen activation and plasmin activity. Used for hyperfibrinolysis in cardiac surgery, trauma, and inherited bleeding disorders. Longer duration than tranexamic acid.
Dosing
Loading: 4-5g over 1hr Maintenance: 1g/hr until bleeding controlled Max dose: 30g/24hr Renal dosing: Reduce by 25-50%
Pharmacokinetics
Onset: Immediate Peak: 2hr Duration: 12hr Metabolism: Minimal Elimination: Renal (86% unchanged) Half-life: 2hr
Pharmacodynamics
Mechanism: Competitive inhibition of plasminogen activation Effects: - Antifibrinolytic - Prevents clot breakdown - Thrombosis risk - No effect on INR/aPTT
Clinical Considerations
Clinical Pearls: 1. Alternative to tranexamic acid 2. Monitor for thrombosis 3. Reduce dose in renal impairment 4. Use in cardiac surgery with high bleeding risk 5. Consider for hemophilia with oral bleeding 6. Less potent than tranexamic acid 7. Longer infusion needed than TXA 8. Higher cost than TXA