Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Aug 11;19(1):54.
doi: 10.1186/s12959-021-00303-9.

Tranexamic acid for the prevention and treatment of bleeding in surgery, trauma and bleeding disorders: a narrative review

Anna Ockerman  1   2 , Thomas Vanassche  3 , Melisa Garip  4   5 , Christophe Vandenbriele  3 , Matthias M Engelen  3 , Jeroen Martens  4   5 , Constantinus Politis  4   5 , Reinhilde Jacobs  4   5   6 , Peter Verhamme  3
Affiliations
Review

Tranexamic acid for the prevention and treatment of bleeding in surgery, trauma and bleeding disorders: a narrative review

Anna Ockerman et al. Thromb J. .

Abstract

Objectives: We review the evidence for tranexamic acid (TXA) for the treatment and prevention of bleeding caused by surgery, trauma and bleeding disorders. We highlight therapeutic areas where evidence is lacking and discuss safety issues, particularly the concern regarding thrombotic complications.

Methods: An electronic search was performed in PubMed and the Cochrane Library to identify clinical trials, safety reports and review articles.

Findings: TXA reduces bleeding in patients with menorrhagia, and in patients undergoing caesarian section, myomectomy, hysterectomy, orthopedic surgery, cardiac surgery, orthognathic surgery, rhinoplasty, and prostate surgery. For dental extractions in patients with bleeding disorders or taking antithrombotic drugs, as well as in cases of idiopathic epistaxis, tonsillectomy, liver transplantation and resection, nephrolithotomy, skin cancer surgery, burn wounds and skin grafting, there is moderate evidence that TXA is effective for reducing bleeding. TXA was not effective in reducing bleeding in traumatic brain injury and upper and lower gastrointestinal bleeding. TXA reduces mortality in patients suffering from trauma and postpartum hemorrhage. For many of these indications, there is no consensus about the optimal TXA dose. With certain dosages and with certain indications TXA can cause harm, such as an increased risk of seizures after high TXA doses with brain injury and cardiac surgery, and an increased mortality after delayed administration of TXA for trauma events or postpartum hemorrhage. Whereas most trials did not signal an increased risk for thrombotic events, some trials reported an increased rate of thrombotic complications with the use of TXA for gastro-intestinal bleeding and trauma.

Conclusions: TXA has well-documented beneficial effects in many clinical indications. Identifying these indications and the optimal dose and timing to minimize risk of seizures or thromboembolic events is work in progress.

PubMed Disclaimer

Conflict of interest statement

All authors have no conflicts of interest to declare. Dr. Verhamme reports grants and personal fees from Bayer Healthcare, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Pfizer, grants and personal fees from BMS, grants and personal fees from Daiichi-Sankyo, grants and personal fees from Leo Pharma, personal fees from Portola and Medtronic, outside the submitted work.

Figures

Fig. 1
Fig. 1
Tranexamic acid can be used to treat or prevent bleeding in various indications. Tranexamic acid is used for prevention and treatment of bleeding in cardiac surgery, epistaxis, gynecologic interventions, postpartum hemorrhage (PPH), menorrhagia, orthopedic surgery, liver surgery and nephrolithotomy, oral and maxillofacial surgery and dental extractions, dermatologic procedures, trauma and bleeding disorders. TXA can be administered orally, intravenously, topically irrigated or on gauzes, and as a mouthwash
See this image and copyright information in PMC

References

    1. Okamoto S, Okamoto U. Amino-Methyl-Cyclohexane-Carboxylic Acid: Amcha a New Potent Inhibitor of the Fibrinolysis. Keio J Med. 1962;11(3):105–13. doi: 10.2302/kjm.11.105. - DOI
    1. Henry D, Carless P, Moxey A, O’Connell D, Stokes B, Fergusson D, et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2011;19(1):CD001886. - PubMed
    1. World Health Organization. WHO Model List of Essential Medicines 20th List. 2017.
    1. Levy JH, Koster A, Quinones QJ, Milling TJ, Key NS. Antifibrinolytic therapy and perioperative considerations. Anesthesiology. 2018;128(3):657–70. doi: 10.1097/ALN.0000000000001997. - DOI - PMC - PubMed
    1. Henry D, Carless P, Fergusson D, Laupacis A. The safety of aprotinin and lysine-derived antifibrinolytic drugs in cardiac surgery: a meta-analysis. Can Med Assoc J. 2009;180(2):183–93. doi: 10.1503/cmaj.081109. - DOI - PMC - PubMed