Tranexamic Acid and Safety in the Right Patient

Tranexamic acid (TXA), an antifibrinolytic agent approved for use in menorrhagia for many decades, has experienced a resurgence of interest and use for both prophylaxis and treatment. TXA works by blocking lysine-binding sites in plasminogen, preventing its binding to fibrin, where it would normally be available for activation by tissue plasminogen activator. It attenuates bleeding if administered early when tissue plasminogen activator is prominent but promotes bleeding if given late when urokinase plasminogen activator is dominant, thereby providing a possible explanation for the observed outcomes of TXA administered after 1 hour from injury and increased mortality when used after 3 hours. There is little doubt that when used appropriately in the various patient populations evaluated with randomized clinical trials, TXA is effective. However, reasonable questions about thrombotic complications remain. The systematic review, meta-analysis, and meta-regression by Taeuber et al attempts to address this issue, yet it evaluated widely diverse populations.
Source: JAMA Surgery - Category: Sports Medicine Source Type: research