Tranexamic acid (Lysteda), used for treating abnormal uterine bleeding, should not be administered with which of the following?

• A. Nonsteroidal antiinflammatory drugs (NSAIDs)
• B. Combination hormonal contraceptives
• C. Statins
• D. Selective serotonin reuptake inhibitors

Answer: (B)

Tranexamic acid is an antifibrinolytic agent commonly used to manage heavy menstrual bleeding, also known as abnormal uterine bleeding. It works by inhibiting the breakdown of fibrin, thus helping to stabilize blood clots.

When considering the use of tranexamic acid with combination hormonal contraceptives, it's important to recognize that both can influence coagulation pathways. Combination hormonal contraceptives contain estrogen and progestin, which can increase the risk of thromboembolic events. The concurrent use of tranexamic acid may further modify the hemostatic balance and could potentially heighten the risk of thrombotic complications, making this combination less safe.

In contrast, the other medications listed do not have a direct contraindication and are generally used with caution alongside tranexamic acid. Nonsteroidal anti-inflammatory drugs (NSAIDs) might be used to manage pain associated with bleeding, statins are unrelated to bleeding management and work on cholesterol levels, while selective serotonin reuptake inhibitors (SSRIs) are typically used for mental health conditions and do not have a known interaction that would pose a risk when combined with tranexamic acid.

Thus, the caution against administering tranexamic acid with combination hormonal contraceptives is primarily due