TXA a Late Bloomer in Bleeding Management

​Tranexamic acid (TXA) was invented by a Japanese husband-and-wife research team in the 1960s. Years earlier, this same research team had discovered epsilon-aminocaproic acid, a derivative and an analogue of the amino acid lysine. In their search for a more potent antifibrinolytic agent, they discovered tranexamic acid, a synthetic analog of the amino acid lysine. Tranexamic acid is eight to 10 times more powerful than epsilon-aminocaproic acid.The antifibrinolytic actions of TXA result from the binding of four or five lysine receptor sites on plasminogen. This binding prevents plasmin from binding to and degrading fibrin, preserving fibrin's matrix structure. Initially, marketing of the drug was for mild bleeding such as heavy menstrual periods and dental extractions. Currently, it is used in surgery to decrease the need for blood transfusions by decreasing bleeding and blood loss.Relatively recently, respectability for this old drug dramatically increased when the 2011 CRASH-2 trial showed that TXA safely and dramatically reduced mortality in bleeding trauma patients. (Lancet 2010;376[9734]:23; http://bit.ly/2CoZJB4.) When treatment was initiated within three hours of injury, the risk of hemorrhage death was reduced by about one-third. Another piece of evidence for the respected stature of this inexpensive and highly cost-effective drug is its inclusion in the WHO list of essential medicines. (http://bit.ly/2CqEpLx.)More recently, topical tranexamic acid has b...
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