Tranexamic acid for treatment and prophylaxis of bleeding and hyperfibrinolysis

Abstract

SummaryUncontrolled massive bleeding with subsequent derangement of the coagulation system is a major challenge in the management of both surgical and seriously injured patients. Under physiological conditions activators and inhibitors of coagulation regulate the sensitive balance between clot formation and fibrinolysis. In some cases, excessive and diffuse bleeding is caused by systemic activation of fibrinolysis, i. e. hyperfibrinolysis (HF). Uncontrolled HF is associated with a high mortality. Polytrauma patients and those undergoing surgical procedures involving organs rich in plasminogen proactivators (e. g. liver, kidney, pancreas, uterus and prostate gland) are at a high risk for HF. Antifibrinolytics, such as tranexamic acid (TXA) are used for prophylaxis and treatment of bleeding caused by a local or generalized HF as well as other hemorrhagic conditions. TXA is a synthetic lysine analogue that has been available in Austria since 1966. TXA is of utmost importance in the prevention and treatment of traumatic and perioperative bleeding due to the resulting reduction in perioperative blood loss and blood transfusion requirements. The following article presents the different fields of application of TXA with particular respect to indications and dosages, based on a literature search and on current guidelines.

COVID-19 infection results in alterations of the kynurenine pathway and fatty acid metabolism that correlate with IL-6 levels and renal status

“…Interestingly, platelets from older subjects are hypercoagulable in the presence of pro-inflammatory stimuli (22), which may help explain the increased mortality rates in older COVID-19 patients. Of note, small molecule metabolites are relevant in treating coagulopathies (e.g., tranexamic acid to treat hyperfibrinolysis in actively bleeding patients) (23). However, to date, nothing is known about the serum metabolome of COVID-19 patients.…”

Preoperative platelet transfusions to reverse antiplatelet therapy for urgent non‐cardiac surgery: an observational cohort study

“…This highlights the importance of defining the optimal time‐point to restart antiplatelet agents in order to prevent bleeding after surgery. We found urologic surgery to be a risk factor for bleeding, which may be caused by increased fibrinolysis in the urogenital tract .…”

Trauma‐targeted delivery of tranexamic acid improves hemostasis and survival in rat liver hemorrhage model

“…Clinical observation of this pathophysiology in trauma patients has prompted robust research into the use of antifibrinolytic agents for clot stabilization and hemostatic benefit. One such agent is trans‐4‐(aminomethyl) cyclohexanecarboxylic acid (tranexamic acid or TXA), a synthetic lysine analog that inhibits tPA, plasminogen as well as plasmin directly . TXA is listed as an “essential medicine” by the World Health Organization for management of heavy menstrual and postpartum hemorrhage.…”

“…One such agent is trans-4-(aminomethyl) cyclohexanecarboxylic acid (tranexamic acid or TXA), a synthetic lysine analog that inhibits tPA, plasminogen as well as plasmin directly. [31][32][33] TXA is listed as an "essential medicine" by the World Health Organization for management of heavy menstrual and postpartum hemorrhage. Recent and ongoing clinical trials indicate a beneficial role of TXA in mitigating traumatic hemorrhage before and while in the hospital.…”