Clinical use of tranexamic acid: evidences and controversies

Contreras, Laura Miranda; Guilabert, Patricia; Koo, Maylin; Méndez, Esther; Sabaté, Antoni

doi:10.1016/j.bjane.2021.08.022

Cited by 20 publications

(14 citation statements)

References 106 publications

(119 reference statements)

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“…Antifibrinolytic drugs, such as tranexamic acid, can also be used for local hemostasis (Davis et al, 2021). However, the dosage of tranexamic acid, mode of administration, and dosing interval affect the hemostatic effect, and high doses of tranexamic acid can cause seizures in patients (Colomina et al, 2021). Therefore, there is an urgent need to develop new hemostasis methods to manage clinical bleeding.…”

Section: Results Referencesmentioning

confidence: 99%

Application of chitosan-based materials in surgical or postoperative hemostasis

et al. 2022

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Uncontrolled bleeding from trauma or surgery remains an important factor affecting the survival and prognosis of surgical patients. Failure to timeously stop bleeding will not only prolong the operative time but also threaten the patient’s life. Timely hemostasis after bleeding has become the most concerned event for surgeons. At present, the most commonly used hemostasis methods in the operating room include ligation of blood vessels, electrocautery, and gauze compression to stop bleeding. However, These hemostatic methods do great harm to surrounding tissues while achieving hemostasis. Based on tissue engineering repair strategies, the use of natural polymer materials as hemostatic agents has achieved clinical success. Gelatin sponge and cellulose gauze have been used clinically with good results. However, gelatin sponges are very expensive and place enormous financial pressure on patients. Therefore, there is an urgent need for new hemostatic materials for surgical hemostasis. Chitosan is a natural polysaccharide with biocompatibility and biodegradability, which plays an important role in tissue engineering and regenerative medicine. Chitosan gauze has been proven to have good hemostatic effects. The positive charge on the surface of chitosan can adsorb red blood cells and platelets at the bleeding site to form platelet thrombosis. However, chitosan is not easily soluble in water and has poor adsorption, which makes it a weak local hemostatic agent. Therefore, it is important to improve chitosan-based hemostatic material such that it l has an excellent hemostatic effect. In this review, we introduce the physiological coagulation process and discuss the physicochemical properties of chitosan and its role in hemostasis. Furthermore, we discuss the advantages and disadvantages of chitosan-based hemostatic materials. Finally, we summarize and discuss chitosan-based hemostatic materials.

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Section: Results Referencesmentioning

confidence: 99%

Application of chitosan-based materials in surgical or postoperative hemostasis

et al. 2022

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“…Possibility of extensive postoperative bleeding or other risks of blood loss are reduced by the antifibrinolytic treatment. At the level of plasminogen activation, fibrinolysis is inhibited by administration of lysine analogues, impairing plasminogen activation to plasmin [ 38 , 39 , 40 ]. Clinically used drugs belonging to this group (i.e., tranexamic acid (TXA) and aminocaproic acid (EACA)) are capable of blocking the LBS of the kringle domains in the plasminogen molecule, which are crucial for interactions of this protein with fibrin and other target surfaces.…”

Section: Current Pro- and Anti-fibrinolytic Therapiesmentioning

confidence: 99%

Plant-Derived Compounds and Extracts as Modulators of Plasmin Activity—A Review

Kołodziejczyk-Czepas

Czepas

2023

Molecules

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Functionality of the fibrinolytic system is based on activity of its central enzyme, plasmin, responsible for the removal of fibrin clots. Besides the hemostasis, fibrinolytic proteins are also involved in many other physiological and pathological processes, including immune response, extracellular matrix degradation, cell migration, and tissue remodeling. Both the impaired and enhanced activity of fibrinolytic proteins may result in serious physiological consequences: prothrombotic state or excessive bleeding, respectively. However, current medicine offers very few options for treating fibrinolytic disorders, particularly in the case of plasmin inhibition. Although numerous attempts have been undertaken to identify natural or to develop engineered fibrinolytic system modulators, structural similarities within serine proteases of the hemostatic system and pleiotropic activity of fibrinolytic proteins constitute a serious problem in discovering anti- or profibrinolytic agents that could precisely affect the target molecules and reduce the risk of side effects. Therefore, this review aims to present a current knowledge of various classes of natural inhibitors and stimulators of the fibrinolytic system being well-defined low-molecular plant secondary metabolites or constituents of plant extracts as well as plant peptides. This work also discusses obstacles caused by low specificity of most of natural compounds and, hence, outlines recent trends in studies aimed at finding more efficient modulators of plasmin activity, including investigation of modifications of natural pharmacophore templates.

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“…This inhibits the interaction of plasminogen with plasmin and fibrin, which results in clot stabilization and reduced fibrinolysis. 4 Tranexamic acid has been in clinical use for >50 years and has been used in a wide range of clinical scenarios to prevent excessive bleeding. These include the use to reduce surgical bleeding in the operating room acute trauma, and in obstetrics to prevent postpartum hemorrhage.…”

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confidence: 99%

“…6 In particular, an unknown risk of administering tranexamic acid in the general surgical population for noncardiac surgery could be an increase in vascular thromboses. 4 A recent metaanalysis of 234 studies with 102,681 patients examined the effect of tranexamic acid on thrombotic events in bleeding patients. Included in the meta-analysis were 124 trials in orthopedic surgery, 47 trials in cardiac surgery, 22 trials in obstetric and gynecologic surgery, 7 trials in trauma (including traumatic brain injury), 9 trials in spontaneous nontraumatic intracranial hemorrhage, and 3 trials in patients with gastrointestinal hemorrhage.…”

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confidence: 99%

“…8,9 The dosing of tranexamic acid is empirical and mainly based on studies in cardiac surgery. 4 Seizures are a dose-dependent side effect of tranexamic acid and are reported in patients receiving doses of more 2 g/day. 7 Trials have reported the importance of timing the administration of tranexamic acid to within 3 hours of bleeding to maximize its efficacy and reduce the risk of thrombotic events.…”

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confidence: 99%

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