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Antifibrinolytic — Surgical Haemostasis (Alternative to Tranexamic Acid)

Aminocaproic Acid

Brand names: Amicar

Aminocaproic acid is an antifibrinolytic agent used to treat or prevent excessive bleeding caused by hyperfibrinolysis.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: ACUTE BLEEDING SYNDROMES DUE TO ELEVATED FIBRINOLYTIC ACTIVITY, INTRAVENOUS INFUSION: US label verbatim — 'it is suggested that 16 to 20 mL (4 to 5 g) of Aminocaproic Acid Injection, USP in 250 mL of diluent be administered by infusion during the first hour of treatment, followed by a continuing infusion at the rate of 4 mL (1 g) per hour in 50 mL of diluent. This method of treatment would ordinarily be continued for about 8 hours or until the bleeding situation has been controlled.'
Route: Intravenous infusion, diluted. 'Aminocaproic Acid Injection, USP is administered by infusion, utilizing the usual compatible intravenous vehicles (e.g., Sterile Water for Injection, Sodium Chloride Injection 0.9%, Dextrose Injection 5% or Ringer's Injection). Although Sterile Water for Injection is compatible for intravenous injection, the resultant solution is hypo-osmolar. RAPID INJECTION OF AMINOCAPROIC ACID INJECTION, USP UNDILUTED INTO A VEIN IS NOT RECOMMENDED.'
Frequency: 4–5 g loading infusion over the first hour, then a continuous infusion of 1 g per hour, 'ordinarily... continued for about 8 hours or until the bleeding situation has been controlled'.
Max: NO MAXIMUM DOSE IS STATED in the fetched DOSAGE AND ADMINISTRATION section for this indication — the label bounds the regimen by DURATION ('about 8 hours or until the bleeding situation has been controlled'), not by a total-dose ceiling. The '30 g/day' figure on the live page appears nowhere in this bundle and must not be presented as a maximum without its own source. The 1 g per hour figure is a RATE, not a ceiling.
Source: US FDA prescribing information (openFDA/DailyMed), Aminocaproic Acid Injection USP, American Regent Inc., label date 2020-07-16. NO UK SPC WAS FETCHED — verify against the UK SPC before publication. ORAL ALTERNATIVE (same indication, clearly scoped, label verbatim): 'If the patient is able to take medication by mouth, an identical dosage regimen may be followed by administering aminocaproic acid tablets or aminocaproic acid syrup, 25% as follows: For the treatment of acute bleeding syndromes due to elevated fibrinolytic activity, it is suggested that 5 grams of aminocaproic acid tablets or syrup be administered during the first hour of treatment, followed by a continuing rate of 1 gram of aminocaproic acid tablets or 1.25 grams of aminocaproic acid syrup per hour. This method of treatment would ordinarily be continued for about 8 hours or until the bleeding situation has been controlled.' Note the oral loading dose is 5 g flat, and the syrup maintenance rate (1.25 g/hour) differs from the tablet rate (1 g/hour). PAEDIATRIC — NO DOSE EXISTS IN THIS SOURCE, so paedDose is null and the live page's '100 mg/kg loading dose IV', '33 mg/kg/hour infusion' and '18 g/m2/day' figures appear NOWHERE in this bundle and must not be carried forward. Label verbatim: 'Safety and effectiveness in pediatric patients have not been established. Aminocaproic Acid Injection, USP contains benzyl alcohol as a preservative. Benzyl alcohol has been associated with a fatal “gasping syndrome” in neonates. The “gasping syndrome”, characterized by central nervous system depression, metabolic acidosis, gasping respirations, and high levels of benzyl alcohol and its metabolites found in the blood and urine, has been associated with exposure to benzyl alcohol in neonates and low-birth weight neonates. Additional symptoms may include gradual neurological deterioration, seizures, intracranial hemorrhage, hematologic abnormalities, skin breakdown, hepatic and renal failure, hypotension, bradycardia, and cardiovascular collapse.' Verify any under-18 use against a children's formulary and with the specialist haematology team. NOT VERIFIED BY THIS SOURCE: the live page's '30 g/day' maximum, its potency comparison with tranexamic acid, its 'reduce dose in renal impairment' statement, and its haematuria / subarachnoid haemorrhage contraindications are all absent from the fetched sections. TRUNCATION: the WARNINGS and PRECAUTIONS sections were NOT retrieved in this bundle, although the adverse-reactions text cross-refers to them for myopathy and for benzyl alcohol — the safety fields below are therefore incomplete.

Dose adjustments

Renal

Not stated in the fetched sections — no renal dose adjustment appears anywhere in this bundle, and WARNINGS/PRECAUTIONS were not retrieved. The live page's 'reduce dose in renal impairment — renally excreted; risk of accumulation' is NOT substantiated by this source. 'BUN increased' and 'renal failure' are listed under Urogenital adverse reactions. Verify against the UK SPC.

Hepatic

Not stated — no hepatic dose adjustment appears in any fetched section of this bundle. Verify against the UK SPC.

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • 'Aminocaproic acid should not be used when there is evidence of an active intravascular clotting process.'
  • Disseminated intravascular coagulation without concomitant heparin — 'Aminocaproic acid must not be used in the presence of DIC without concomitant heparin.'
  • Before use, primary fibrinolysis must be distinguished from DIC: 'Platelet count is usually decreased in DIC but normal in primary fibrinolysis. Protamine paracoagulation test is positive in DIC... The test is negative in the presence of primary fibrinolysis. The euglobulin clot lysis test is abnormal in primary fibrinolysis but normal in DIC.'
  • NOTE: this is the complete CONTRAINDICATIONS section as fetched — the haematuria and subarachnoid haemorrhage items on the live page are not in this source

Side effects

  • General: oedema, headache, malaise
  • Hypersensitivity: allergic and anaphylactoid reactions, anaphylaxis
  • Local: injection site reactions, pain and necrosis
  • Cardiovascular: bradycardia, hypotension, peripheral ischaemia, thrombosis
  • Gastrointestinal: abdominal pain, diarrhoea, nausea, vomiting
  • Haematologic: agranulocytosis, coagulation disorder, leukopenia, thrombocytopenia
  • Musculoskeletal: CPK increased, muscle weakness, myalgia, myopathy (label cross-refers to WARNINGS), myositis, rhabdomyolysis
  • Neurologic: confusion, convulsions, delirium, dizziness, hallucinations, intracranial hypertension, stroke, syncope
  • Respiratory: dyspnoea, nasal congestion, pulmonary embolism
  • Skin: pruritus, rash. Special senses: tinnitus, vision decreased, watery eyes
  • Urogenital: BUN increased, renal failure; 'There have been some reports of dry ejaculation during the period of aminocaproic acid treatment... this symptom resolved in all patients within 24 to 48 hours of completion of therapy.'

Monitoring

  • DIAGNOSTIC PREREQUISITE — before giving the drug, confirm the bleeding is primary fibrinolysis and not DIC: 'When there is uncertainty as to whether the cause of bleeding is primary fibrinolysis or disseminated intravascular coagulation (DIC), this distinction must be made before administering aminocaproic acid', using platelet count (decreased in DIC, normal in primary fibrinolysis), the protamine paracoagulation test (positive in DIC, negative in primary fibrinolysis) and the euglobulin clot lysis test (abnormal in primary fibrinolysis, normal in DIC).
  • MUSCLE INJURY: the adverse-reactions list carries CPK increased, muscle weakness, myalgia, myopathy (cross-referred to WARNINGS), myositis and rhabdomyolysis — monitor creatine kinase where treatment is prolonged.
  • THROMBOSIS: peripheral ischaemia, thrombosis and pulmonary embolism are listed adverse reactions.
  • HAEMATOLOGY: agranulocytosis, leukopenia and thrombocytopenia are listed.
  • RENAL: BUN increased and renal failure are listed.
  • ADMINISTRATION: never give undiluted by rapid intravenous injection
  • inspect visually for particulate matter and discoloration before administration.
  • NOTE: the WARNINGS and PRECAUTIONS sections were NOT retrieved in this bundle, so this monitoring set is incomplete — read them in the UK SPC.

Clinical monograph

How it works

It inhibits fibrinolysis by blocking the binding of plasminogen and plasmin to fibrin, thereby stabilising clots and reducing their breakdown.

Prescribing in practice

  • Avoid use when there is active intravascular clotting or disseminated intravascular coagulation unless given with appropriate anticoagulation, because of thrombotic risk.
  • Use with caution in renal impairment and in the presence of haematuria from an upper urinary tract source, where clot retention may occur.
  • It is closely related in action to tranexamic acid, which is more commonly used in UK practice.

Monitoring

Monitor for signs of thrombosis and review for resolution of bleeding, with caution in renal impairment.

Counselling the patient

  • This medicine helps reduce bleeding by slowing the breakdown of blood clots.
  • Report any leg pain, swelling, chest pain or breathlessness promptly.
  • Tell the team about any kidney problems or blood in the urine.

Evidence & guidelines

Antifibrinolytic therapy is an established approach to reducing bleeding in hyperfibrinolytic states.

Reference: MHRA SPC Amicar; BSH Perioperative Haemostasis Guidelines; Perioperative Antifibrinolytic Review; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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