New and Off-Label Uses of Tranexamic Acid

Johnson, S.; Tsang, Dawn; Dansby, Mary; Allen, C. E.

doi:10.4037/aacnacc2021193

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…Tranexamic acid (TXA), an antifibrinolytic drug, now is a staple in the orthopaedic surgeon's toolkit to minimize blood loss and blood transfusions during and after surgery, although the FDA and Health Canada have not approved it for this indication [5].…”

Section: Importance Of the Topicmentioning

confidence: 99%

Cochrane in CORR®: Pharmacological Interventions for the Prevention of Bleeding in People Undergoing Definitive Fixation or Joint Replacement for Hip, Pelvic and Long Bone Fractures

Madden,

Adili

2024

Clin Orthop Relat Res

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We are pleased to publish the next installment of "Cochrane in CORR ® ", our partnership between CORR ® , The Cochrane Collaboration ® , and McMaster University's Evidence-Based Orthopaedics Group. In this column, researchers from McMaster University and other institutions will provide expert perspective on an abstract originally published in The Cochrane Library that we think is especially important. We welcome reader feedback on our editorials as we do on all of our columns and articles; please send your comments to

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Section: Importance Of the Topicmentioning

confidence: 99%

Cochrane in CORR®: Pharmacological Interventions for the Prevention of Bleeding in People Undergoing Definitive Fixation or Joint Replacement for Hip, Pelvic and Long Bone Fractures

Madden,

Adili

2024

Clin Orthop Relat Res

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“…The US American Food and Drug Administration (FDA) approved the application of TXA for the treatment of menorrhagia and the prevention of short-term bleeding during tooth extraction in patients with hemophilia. Even though the European Medicines Agency and Pharmaceuticals and Medical Devices Agency have approved TXA for use in a broader range of indications ( Table 1 ), off-label uses in emergency trauma medicine 23 , orthopedic surgery 24 , 25 , 26 and dermatology (melasma treatment 27 ) are common clinical practice 28 .…”

Section: Clinical Usage and Efficacy Of Txamentioning

confidence: 99%

The emerging role of tranexamic acid and its principal target, plasminogen, in skeletal health

Xie,

Donat,

Jiang

et al. 2024

Acta Pharmaceutica Sinica B

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“…Current evidence suggests that early TXA hemostatic administration may improve outcomes in trauma patients both with hemorrhagic shock and intracranial bleeding [ 15 ]. Moreover, in cases of uncontrollable hemorrhage and coagulopathy, the off-label use of TXA has been suggested [ 1 , 16 ]. While recombinant activated coagulation factor VII (rFVIIa) has been rarely investigated and used in the pre-hospital arena [ 17 ], TXA was tested by several published studies [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Systemic hemostatic agents initiated in trauma patients in the pre-hospital setting: a systematic review

Biffi

Porcu

Castellini

et al. 2022

Eur J Trauma Emerg Surg

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Purpose The effect of systemic hemostatic agents initiated during pre-hospital care of severely injured patients with ongoing bleeding or traumatic brain injury (TBI) remains controversial. A systematic review and meta-analysis was therefore conducted to assess the effectiveness and safety of systemic hemostatic agents as an adjunctive therapy in people with major trauma and hemorrhage or TBI in the context of developing the Italian National Institute of Health guidelines on major trauma integrated management. Methods PubMed, Embase, and Cochrane Library databases were searched up to October 2021 for studies that investigated pre-hospital initiated treatment with systemic hemostatic agents. The certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation approach, and the quality of each study was determined with the Cochrane risk-of-bias tool. The primary outcome was overall mortality, and secondary outcomes included cause-specific mortality, health-related quality of life, any adverse effects and blood product use, hemorrhage expansion, and patient-reported outcomes. Results Five trials of tranexamic acid (TXA) met the inclusion criteria for this meta-analysis. With a high certainty of evidence, when compared to placebo TXA reduced mortality at 24 h (relative risk = 0.83, 95% confidence interval = 0.73–0.94) and at 1 month among trauma patients (0.91, 0.85–0.97). These results depend on the subgroup of patients with significant hemorrhage because in the subgroup of TBI there are no difference between TXA and placebo. TXA also reduced bleeding death and multiple organ failure whereas no difference in health-related quality of life. Conclusion Balancing benefits and harms, TXA initiated in the pre-hospital setting can be used for patients experiencing major trauma with significant hemorrhage since it reduces the risk of mortality at 24 h and one month with no difference in terms of adverse effects when compared to placebo. Considering the subgroup of severe TBI, no difference in mortality rate was found at 24 h and one month. These results highlight the need to conduct future studies to investigate the role of other systemic hemostatic agents in the pre-hospital settings.

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New and Off-Label Uses of Tranexamic Acid

Cited by 4 publications

References 17 publications

Cochrane in CORR®: Pharmacological Interventions for the Prevention of Bleeding in People Undergoing Definitive Fixation or Joint Replacement for Hip, Pelvic and Long Bone Fractures

Cochrane in CORR®: Pharmacological Interventions for the Prevention of Bleeding in People Undergoing Definitive Fixation or Joint Replacement for Hip, Pelvic and Long Bone Fractures

The emerging role of tranexamic acid and its principal target, plasminogen, in skeletal health

Systemic hemostatic agents initiated in trauma patients in the pre-hospital setting: a systematic review

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