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REVIEW article

Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1416998
This article is part of the Research Topic Patient Blood Management and Transfusion Strategies in Perioperative Settings View all articles

Tranexamic acid: A narrative review of its current role in perioperative medicine and acute medical bleeding

Provisionally accepted
Marwan Bouras Marwan Bouras 1,2*Alexandre Bourdiol Alexandre Bourdiol 3Paul Rooze Paul Rooze 3Yannick Hourmant Yannick Hourmant 3Anaïs Caillard Anaïs Caillard 1Antoine Roquilly Antoine Roquilly 2,3
  • 1 Centre Hospitalier Regional Universitaire (CHU) de Brest, Brest, Brittany, France
  • 2 INSERM U1064 Centre de Recherche en Transplantation et Immunologie, Nantes, Pays de la Loire, France
  • 3 Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, Pays de la Loire, France

The final, formatted version of the article will be published soon.

    Purpose: Tranexamic acid (TXA) is the most widely prescribed antifibrinolytic for active bleeding or to prevent surgical bleeding. Despite numerous large multi-center randomized trials involving thousands of patients being conducted, TXA remains underutilized in indications where it has demonstrated efficacy and a lack of harmful effects. This narrative review aims to provide basic concepts about fibrinolysis and TXA's mode of action and is focused on the most recent and important trials evaluating this drug in different hemorrhagic situations.Methods: We selected every low bias RCT, and we highlighted their strengths and limitations throughout this review.Principal Findings: While TXA appears to have a favorable benefit-risk ratio in most situations (trauma, obstetrics, at-risk for bleeding surgeries) evidence of benefit is lacking in certain medical settings (SAH, digestive bleeding).Conclusion: Although in some situations the drug's effect on significant outcomes is modest, its favorable safety profile allows it to be recommended for trauma patients, in obstetrics, and in scheduled surgeries at risk of bleeding. However, it cannot be recommended in cases of spontaneous intracranial bleeding, subarachnoid hemorrhage (SAH), or gastrointestinal bleeding.

    Keywords: Tranexamic Acid, Fibrinolysis, Hemorrhage, Trauma, Postpartum Hemorrhage, scheduled surgery, Acute care

    Received: 13 Apr 2024; Accepted: 31 Jul 2024.

    Copyright: © 2024 Bouras, Bourdiol, Rooze, Hourmant, Caillard and Roquilly. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Marwan Bouras, Centre Hospitalier Regional Universitaire (CHU) de Brest, Brest, 29200, Brittany, France

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.