The Role of Tranexamic Acid in the Management of an Acutely Hemorrhaging Patient

Abstract

Background: Acute hemorrhage, both traumatic and nontraumatic, leads to significant morbidity and mortality, both in the United States and globally. Traditional treatment of acute hemorrhage is focused on hemostasis and blood product replacement. Tranexamic acid is an antifibrinolytic agent that may reduce acute hemorrhage through inhibition of plasminogen. Newer research suggests that coagulopathy, specifically fibrinolysis, may contribute significantly to the pathology of acute hemorrhage. Methods: We searched the PubMed database for relevant articles from 2000 to 2018 for the terms “tranexamic acid,” “TXA,” “antifibrinolytic,” “hyperfibrinolysis,” and “coagulopathy.” Our search was limited to studies published in the English language. Results: A total of 53 studies were included in this review. These articles suggest a potential role for tranexamic acid in the management of acute intracranial hemorrhage, epistaxis, hematuria, postpartum hemorrhage, gastrointestinal hemorrhage, and trauma-related hemorrhage. A theoretical risk of thrombotic events following tranexamic acid use exists, though large clinical trials suggest this risk remains exceedingly small. Conclusions: Recent studies suggest a mortality benefit with tranexamic acid following acute hemorrhage. First responders such as emergency medical technicians and emergency department clinicians should consider tranexamic acid as an adjunct therapy in the management of acute, severe traumatic and nontraumatic hemorrhage.

Application of chitosan-based materials in surgical or postoperative hemostasis

“…In addition, smoke blocks the surgical field of view and prolongs the operative time (Gioutsos et al, 2022). 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).…”

Efficacy and safety of tranexamic acid in the treatment of gastric cancer complicated with upper gastrointestinal bleeding

“…At present, there are no guidelines that provide clear recommendations on the use of TXA for the treatment of GI bleeding [23]. However, another study suggested that TXA was not recommended for patients with acute GI bleeding until further strong evidence emerges [24]. hospital-based single-center study.…”

Outcomes of 4-factor Prothrombin Complex Concentrate in Patients With Liver Disease and Nonvitamin K Antagonist-Related Coagulopathy: A Retrospective Study

“…Given that this was a retrospective review, we could only infer correlations, not causality. Continued education and investigation regarding the use of 4F-PCC is necessary to maximize its clinical applications and effectiveness while maintaining patient safety, similar to the case with other agents for VKA reversal, such as vitamin K. 19 It is not uncommon for hemostatic medications, such as tranexamic acid 20 and activated factor VII, 21,22 to be administered in uncontrolled hemorrhage settings. Despite the known risks of these medications, which are predominately thromboembolic events, 23 they have been increasingly incorporated into daily clinical practice.…”

“…It is not uncommon for hemostatic medications, such as tranexamic acid 20 and activated factor VII, 21 , 22 to be administered in uncontrolled hemorrhage settings. Despite the known risks of these medications, which are predominately thromboembolic events, 23 they have been increasingly incorporated into daily clinical practice.…”