Tranexamic Acid and Its Potential Anti-Inflammatory Effect: A Systematic Review

Abstract

Tranexamic acid (TXA) is an antifibrinolytic drug primarily used for reducing blood loss in patients with major bleedings. Animal and cell studies have shown that TXA might modulate the inflammatory response by either enhancing or inhibiting cytokine levels. Furthermore, recent human studies have found altered inflammatory biomarkers in patients receiving TXA when compared with patients who did not receive TXA. In this systematic review we investigated the effect of TXA on inflammatory biomarkers in different patient groups. A systematic literature search was conducted on the databases PubMed and Embase to identify all original articles that investigated inflammatory biomarkers in patients receiving TXA and compared them to a relevant control group. The review was performed according to the PRISMA guidelines, and the literature search was performed on November 29, 2021. Thirty-three studies were included, among which 14 studies compared patients receiving TXA with patients getting no medication, another 14 studies investigated different dosing regimens of TXA, and finally five studies examined the administration form of TXA. The present review suggests that TXA has an anti-inflammatory effect in patients undergoing orthopaedic surgery illustrated by decreased levels of C-reactive protein and interleukin-6 in patients receiving TXA compared with patients receiving no or lower doses of TXA. However, the anti-inflammatory effect was not found in patients undergoing cardiac surgery, pediatric craniosynostosis patients, or in rheumatoid arthritis patients. The inflammatory response was not affected by administration form of TXA (oral, intravenous, or topical). In conclusion, an anti-inflammatory effect of TXA was consistently found among orthopaedic patients only.

Topical use of tranexamic acid can reduce opioid consumption for patients undergoing primary total hip arthroplasty: a prospective randomized controlled trial

“…Wang et al [25] found that oral administration of 1 g TXA at 3 hours, 7 hours, 11 hours, and 15 hours after surgery minimized postoperative bleeding and in ammation in knee joint replacements, thereby reducing pain and promoting rapid recovery. Okholm et al showed that perioperative use of TXA in orthopedic patients was associated with decreased C-reactive protein and interleukin-6 levels compared to those who did not receive or received lower doses of TXA [27]. Similar to the above ndings, in our study, CRP level (22.09 ± 5.68 vs. 24.01 ± 5.84, P = 0.036), IL-6 level (14.87 ± 3.14 vs. 16.51 ± 3.09, P = 0.001) and ESR level (38.65 ± 7.51 vs. 42.84 ± 6.28, P<0.001) on the rst postoperative day were lower in the topical group than in the intravenous group, which has some correlation with the topical use of TXA inhibiting the local surgical area in ammatory response.…”

Effect of tranexamic acid on endothelial von Willebrand factor/ADAMTS-13 response to in vitro shock conditions

“…TXA has a number of demonstrated anti-inflammatory effects outside of its antifibrinolytic properties. [18][19][20][21] These include its function as a non-selective serine protease inhibitor. Membrane anchored metalloproteinases are integral components in the regulation of the vascular barrier in vivo.…”

“…TXA has a number of demonstrated anti-inflammatory effects outside of its antifibrinolytic properties 18–21 . These include its function as a non-selective serine protease inhibitor.…”

The Neuroendothelial Axis in Traumatic Brain Injury: Mechanisms of Multiorgan Dysfunction, Novel Therapies, and Future Directions

“…Tranexamic acid (TXA) is a competitive serine protease inhibitor that prevents the conversion of plasminogen to plasmin, which in turn stabilizes clot. It also has anti-inflammatory properties (169,170). CRASH-2 and CRASH-3 trials have demonstrated that TXA administration improves survival (171) and reduces head injury-related deaths (172) when administered within 3 h of injury, and it has now been added to many massive transfusion protocols (173) Diebel et al (136) have demonstrated that TXA treatment of ECs in vitro 30 min after injury was associated with decreased permeability, reduced ICAM expression, and decreased SDC-1 and sTM expressions.…”