Positive impact of tranexamic acid in various medical settings
DOI:
https://doi.org/10.56782/pps.248Keywords:
tranexamic acid , antifibrinolytic agents , bleeding , traumaAbstract
The role of successful hemostasis cannot be overemphasized. Bleeding can occur due to various reasons and its cause is not always evident. Any delay in restoring proper hemostasis is associated with an increased risk of complications and therefore results in increased mortality. Discovered in 1962 by Japanese researchers Shosuke and Utako Okamoto, tranexamic acid (TXA) is an anti-fibrinolytic agent that inhibits plasminogen activation by blocking the lysine binding sites on plasminogen. Thanks to its ability to inhibit fibrinolysis it stabilizes the preformed fibrin mesh-work and has a beneficial effect in reducing blood loss in a wide range of clinical settings. TXA has been shown to reduce the risk of perioperative bleeding in patients undergoing noncardiac surgeries. CRASH (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage) trials provided the largest body of evidence confirming the effectiveness of early administration of TXA, defined as administration within 3 hours after trauma, in reducing mortality in patients with severe injuries and traumatic brain injury. Recent evidence indicates that TXA administration in the treatment of postpartum hemorrhage results in notable mortality reduction. Topical or locally injected tranexamic acid may reduce blood loss with negligible risk of systemic adverse effects. More high-quality studies are needed to determine safety, efficacy, and dosage. The risk of serious adverse events, especially vascular occlusive events, in patients receiving TXA compared to the placebo group did not differ significantly.
Downloads
References
Ausen, K.; Fossmark, R.; Spigset, O.; Pleym, H. Safety and Efficacy of Local Tranexamic Acid for the Prevention of Surgical Bleeding in Soft-Tissue Surgery: A Review of the Literature and Recommendations for Plastic Surgery. Plast. Reconst. Surg. 2022, 149 (3), 774–787. DOI: 10.1097/prs.0000000000008884 DOI: https://doi.org/10.1097/PRS.0000000000008884
Scarafoni, E. A Systematic Review of Tranexamic Acid in Plastic Surgery: What’s New? PRS Global Open 2021, 9 (3), e3172. DOI: 10.1097/GOX.0000000000003172 DOI: https://doi.org/10.1097/GOX.0000000000003172
Murkin, J. M. Lessons Learned in Antifibrinolytic Therapy: The BART Trial. Semin. Cardiothorac. Vasc. Anesth. 2009, 13 (2), 127–131. DOI: 10.1177/1089253209338076 DOI: https://doi.org/10.1177/1089253209338076
Ker, K.; Prieto-Merino, D.; Roberts, I. Systematic Review, Meta-Analysis and Meta-Regression of the Effect of Tranexamic Acid on Surgical Blood Loss. Br. J. Surg. 2013, 100 (10), 1271–1279. DOI: 10.1002/bjs.9193 DOI: https://doi.org/10.1002/bjs.9193
Henry, D. A.; Carless, P. A.; Moxey, A. J.; O’Connell, D.; Stokes, B. J.; Fergusson, D. A.; Ker, K. Anti-Fibrinolytic Use for Minimising Perioperative Allogeneic Blood Transfusion. Cochrane Database Syst. Rev. 2011. DOI: 10.1002/14651858.cd001886.pub3 DOI: https://doi.org/10.1002/14651858.CD001886.pub3
Franchini, M.; Mannucci, P. M. The Never Ending Success Story of Tranexamic Acid in Acquired Bleeding. Haematol. 2020, 105 (5), 1201–1205. DOI: 10.3324/haematol.2020.250720 DOI: https://doi.org/10.3324/haematol.2020.250720
Charakterystyka produktu leczniczego EXACYL (Kwas Traneksamowy) [accesed and cited 01.07.2024]. Available: from: https://rejestry.ezdrowie.gov.pl/api/rpl/medicinal-products/2331/characteristic.
Cai, J.; Ribkoff, J.; Olson, S.; Raghunathan, V.; Al‐Samkari, H.; DeLoughery, T. G.; Shatzel, J. J. The Many Roles of Tranexamic Acid: An Overview of the Clinical Indications for TXA in Medical and Surgical Patients. Eur. J. Haematol. 2019, 104 (2), 79–87. DOI: 10.1111/ejh.13348 DOI: https://doi.org/10.1111/ejh.13348
Devereaux, P. J.; Marcucci, M.; Painter, T. W.; Conen, D.; Lomivorotov, V.; Sessler, D. I.; Chan, M. T. V.; Borges, F. K.; Martínez-Zapata, M. J.; Wang, C. Y.; Xavier, D.; Ofori, S. N.; Wang, M. K.; Efremov, S.; Landoni, G.; Kleinlugtenbelt, Y. V.; Szczeklik, W.; Schmartz, D.; Garg, A. X.; Short, T. G. Tranexamic Acid in Patients Undergoing Noncardiac Surgery. N. Engl. J. Med. 2022. 386(21), 1986-1997 DOI: 10.1056/nejmoa2201171 DOI: https://doi.org/10.1056/NEJMoa2201171
Marcucci, M.; Painter, T. W.; Conen, D.; Leslie, K.; Lomivorotov, V. V.; Sessler, D.; Chan, M. T. V.; Borges, F. K.; Martínez Zapata, M. J.; Wang, C. Y.; Xavier, D.; Ofori, S. N.; Landoni, G.; Efremov, S.; Kleinlugtenbelt, Y. V.; Szczeklik, W.; Schmartz, D.; Garg, A. X.; Short, T. G.; Wittmann, M. Rationale and Design of the PeriOperative ISchemic Evaluation-3 (POISE-3): A Randomized Controlled Trial Evaluating Tranexamic Acid and a Strategy to Minimize Hypotension in Noncardiac Surgery. Trials 2022, 23 (1). DOI: 10.1186/s13063-021-05992-1 DOI: https://doi.org/10.1186/s13063-021-05992-1
Grocott, M. P. W.; Murphy, M.; Roberts, I.; Sayers, R.; Toh, C.-H. Tranexamic Acid for Safer Surgery: The Time Is Now. Br. J. Anaesth. 2022, 129 (4), 459–461. DOI: 10.1016/j.bja.2022.06.024 DOI: https://doi.org/10.1016/j.bja.2022.06.024
Shehata, N.; Forster, A.; Lawrence, N.; Rothwell, D. M.; Fergusson, D.; Tinmouth, A.; Wilson, K. Changing Trends in Blood Transfusion: An Analysis of 244,013 Hospitalizations. Transfusion 2014, 54 (10pt2), 2631–2639. DOI: 10.1111/trf.12644 DOI: https://doi.org/10.1111/trf.12644
Dewan, Y.; Komolafe, E. O.; Mejía-Mantilla, J. H.; Perel, P.; Roberts, I.; Shakur, H. CRASH-3 - Tranexamic Acid for the Treatment of Significant Traumatic Brain Injury: Study Protocol for an International Randomized, Double-Blind, Placebo-Controlled Trial. Trials 2012, 13 (1). DOI: 10.1186/1745-6215-13-87 DOI: https://doi.org/10.1186/1745-6215-13-87
Roberts, I.; Belli, A.; Brenner, A.; Chaudhri, R.; Fawole, B.; Harris, T.; Jooma, R.; Mahmood, A.; Shokunbi, T.; Shakur, H. Tranexamic Acid for Significant Traumatic Brain Injury (the CRASH-3 Trial): Statistical Analysis Plan for an International, Randomised, Double-Blind, Placebo-Controlled Trial. Wellcome Open Res. 2018, 3, 86. DOI: 10.12688/wellcomeopenres.14700.2 DOI: https://doi.org/10.12688/wellcomeopenres.14700.1
The CRASH-3 trial collaborators. Effects of Tranexamic Acid on Death, Disability, Vascular Occlusive Events and Other Morbidities in Patients with Acute Traumatic Brain Injury (CRASH-3): A Randomised, Placebo-Controlled Trial. The Lancet 2019, 394 (10210), 1713–1723. DOI: 10.1016/s0140-6736(19)32233-0 DOI: https://doi.org/10.1016/S0140-6736(19)32233-0
Koh, A.; Adiamah, A.; Gomez, D.; Sanyal, S. Safety and efficacy of tranexamic acid in minimizing perioperative bleeding in extrahepatic abdominal surgery: meta-analysis. BJS Open 2021, 5 (2). DOI: 10.1093/bjsopen/zrab004 DOI: https://doi.org/10.1093/bjsopen/zrab004
Mansukhani, R.; Frimley, L.; Shakur-Still, H.; Sharples, L.; Roberts, I. Accuracy of Time to Treatment Estimates in the CRASH-3 Clinical Trial: Impact on the Trial Results. Trials 2020, 21 (1). DOI: 10.1186/s13063-020-04623-5 DOI: https://doi.org/10.1186/s13063-020-04623-5
Oyelese, Y.; Scorza, W. E.; Mastrolia, R.; Smulian, J. C. Postpartum Hemorrhage. Obstet. Gynecol. Clin. North. Am. 2007, 34 (3), 421–441. DOI: 10.1016/j.ogc.2007.06.007 DOI: https://doi.org/10.1016/j.ogc.2007.06.007
Shakur, H.; Elbourne, D.; Gülmezoglu, M.; Alfirevic, Z.; Ronsmans, C.; Allen, E.; Roberts, I. The WOMAN Trial (World Maternal Antifibrinolytic Trial): Tranexamic Acid for the Treatment of Postpartum Haemorrhage: An International Randomised, Double Blind Placebo Controlled Trial. Trials 2010, 11 (1). DOI: 10.1186/1745-6215-11-40 DOI: https://doi.org/10.1186/1745-6215-11-40
Updated WHO Recommendation on Tranexamic Acid for the Treatment of Postpartum Haemorrhage [accesed and cited 01.07.2024]. Available from: https://iris.who.int/bitstream/handle/10665/259379/WHO-RHR-17.21-eng.pdf.
Myles, P. S.; Smith, J. A.; Forbes, A.; Silbert, B.; Jayarajah, M.; Painter, T.; Cooper, D. J.; Marasco, S.; McNeil, J.; Bussières, J. S.; McGuinness, S.; Byrne, K.; Chan, M. T. V.; Landoni, G.; Wallace, S. Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery. N. Engl. J. Med. 2017, 376 (2), 136–148. DOI: 10.1056/nejmoa1606424 DOI: https://doi.org/10.1056/NEJMoa1606424
Shi, J.; Zhou, C.; Liu, S.; Sun, H.; Wang, Y.; Yan, F.; Pan, W.; Zheng, Z. Outcome Impact of Different Tranexamic Acid Regimens in Cardiac Surgery with Cardiopulmonary Bypass (OPTIMAL): Rationale, Design, and Study Protocol of a Multicenter Randomized Controlled Trial. Am. Heart J. 2020, 222, 147–156. DOI: 10.1016/j.ahj.2019.09.010 DOI: https://doi.org/10.1016/j.ahj.2019.09.010
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Katarzyna Herjan, Piotr Armański, Jakub Olszewski, Magdalena Sitnik, Maciej Bara
This work is licensed under a Creative Commons Attribution 4.0 International License.
For all articles published in Prospects in Pharmaceutical Sciences copyright is retained by the authors. The journal publishes articles in the Open Access policy, within the CC BY 4.0 licence.
This is a human-readable summary of (and not a substitute for) the license. Disclaimer.
You are free to:
Share — copy and redistribute the material in any medium or format
Adapt — remix, transform, and build upon the material for any purpose, even commercially.
The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation.
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
How to Cite
