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. 2025 Aug;81(8):1119-1127.
doi: 10.1007/s00228-025-03857-z. Epub 2025 Jun 2.

Tranexamic acid-induced anaphylaxis: a systematic review

Pei-Shuang Lin  1   2 , Yun-Tai Yao  3   4   5   6 , Alparslan Turan  7   8 , Daniel I Sessler  7   8
Affiliations

Tranexamic acid-induced anaphylaxis: a systematic review

Pei-Shuang Lin et al. Eur J Clin Pharmacol. 2025 Aug.

Abstract

Purpose: Tranexamic acid (TXA) is a synthetic antifibrinolytic agent widely used in a diverse range of hemorrhagic scenarios. Despite documented superior safety profile, increasing reports have emerged describing anaphylactic reactions to TXA. We reviewed reported cases of anaphylactic reactions to TXA and summarize their clinical characteristics, diagnosis and treatment protocols.

Methods: PubMed, Embase, Web of Science were searched with the terms "tranexamic acid", "antifibrinoly*", "anaphylaxis", "anaphylactic", "anaphylactoid", "allergy" and "hypersensitivity" to identify relevant case reports. Data were extracted and analyzed.

Results: Our review identified 15 cases of TXA-induced anaphylaxis. Patients were 2 to 80 years old, with 60.0% adults. The most common symptoms were hypotension, hypoxia and rash in an equal 66.7%, followed by tachycardia in 60.0%. TXA was confirmed as the culprit allergen in 73.3% of cases through allergological workup. Major treatments consisted of corticosteroids (80.0%), epinephrine (73.3%) and antihistamine (60.0%). While most patients recovered, 1 patient experienced recurrent anaphylaxis and 1 patient died.

Conclusions: Anaphylaxis to TXA is a rare drug adverse reaction with varying manifestations. Prompt recognition and appropriate treatment are critical in facilitating optimal outcomes.

Keywords: Adverse reaction; Allergy; Anaphylaxis; Skin test; Tranexamic acid.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

References

    1. Ng W, Jerath A, Wąsowicz M (2015) Tranexamic acid: a clinical review. Anaesthesiol Intensive Ther 47:339–350. https://doi.org/10.5603/AIT.a2015.0011 - DOI - PubMed
    1. Hunt BJ (2015) The current place of tranexamic acid in the management of bleeding. Anaesthesia 70(Suppl 1):50–53, e18. https://doi.org/10.1111/anae.12910 - DOI - PubMed
    1. Colomina MJ, Contreras L, Guilabert P et al (2022) Clinical use of tranexamic acid: evidences and controversies. Braz J Anesthesiol 72:795–812. https://doi.org/10.1016/j.bjane.2021.08.022 - DOI - PubMed
    1. CRASH-2 Trial Collaborators; Shakur H, Roberts I, Bautista R et al (2010) Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 376:23-32. https://doi.org/10.1016/S0140-6736(10)60835-5
    1. WOMAN Trial Collaborators (2017) Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 389:2105–2116. https://doi.org/10.1016/S0140-6736(17)30638-4 - DOI

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