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
. 2022 Aug:62 Suppl 1:S301-S312.
doi: 10.1111/trf.16976. Epub 2022 Jul 14.

Tranexamic acid: Beyond antifibrinolysis

Igor Prudovsky  1 , Doreen Kacer  1 , Victoria Vieira Zucco  1 , Monica Palmeri  2 , Carolyne Falank  3 , Robert Kramer  2 , Damien Carter  3 , Joseph Rappold  1   3
Affiliations
Review

Tranexamic acid: Beyond antifibrinolysis

Igor Prudovsky et al. Transfusion. 2022 Aug.

Abstract

Tranexamic acid (TXA) is a popular antifibrinolytic drug widely used in hemorrhagic trauma patients and cardiovascular, orthopedic, and gynecological surgical patients. TXA binds plasminogen and prevents its maturation to the fibrinolytic enzyme plasmin. A number of studies have demonstrated the broad life-saving effects of TXA in trauma, superior to those of other antifibrinolytic agents. Besides preventing fibrinolysis and blood loss, TXA has been reported to suppress posttraumatic inflammation and edema. Although the efficiency of TXA transcends simple inhibition of fibrinolysis, little is known about its mechanisms of action besides the suppression of plasmin maturation. Understanding the broader effects of TXA at the cell, organ, and organism levels are required to elucidate its potential mechanisms of action transcending antifibrinolytic activity. In this article, we provide a brief review of the current clinical use of TXA and then focus on the effects of TXA beyond antifibrinolytics such as its anti-inflammatory activity, protection of the endothelial and epithelial monolayers, stimulation of mitochondrial respiration, and suppression of melanogenesis.

Keywords: hemorrhage; inflammation; mitochondria; plasmin; tranexamic acid.

PubMed Disclaimer

References

REFERENCES

    1. Franchini M, Mannucci PM. Adjunct agents for bleeding. Curr Opin Hematol. 2014;21(6):503-8. https://doi.org/10.1097/MOH.0000000000000084
    1. Dietrich W. Aprotinin: 1 year on. Curr Opin Anaesthesiol. 2009;22(1):121-7. https://doi.org/10.1097/ACO.0b013e32831c833f
    1. Hoover GJ, Menhart N, Martin A, Warder S, Castellino FJ. Amino acids of the recombinant kringle 1 domain of human plasminogen that stabilize its interaction with omega-amino acids. Biochemistry. 1993;32(41):10936-43. https://doi.org/10.1021/bi00092a002
    1. Takada A, Takada Y. Inhibition by tranexamic acid of the conversion of single-chain tissue plasmogin activator to its two chain form by plasmin: the presence on tissue plasminogen activator of a site to bind with lysine binding sites of plasmin. Thromb Res. 1989;55(6):717-25. https://doi.org/10.1016/0049-3848(89)90302-2
    1. Liu Q, Geng P, Shi L, Wang Q, Wang P. Tranexamic acid versus aminocaproic acid for blood management after total knee and total hip arthroplasty: a systematic review and meta-analysis. Int J Surg. 2018;54:105-12. https://doi.org/10.1016/j.ijsu.2018.04.042

Publication types

MeSH terms

LinkOut - more resources