Tranexamic acid for treatment and prophylaxis of bleeding and hyperfibrinolysis.

Ingrid Pabinger,Werner Streif,Dietmar Fries,Wolfgang Toller,Herbert Schöchl

doi:10.1007/s00508-017-1194-y

Abstract

SummaryUncontrolled massive bleeding with subsequent derangement of the coagulation system is a major challenge in the management of both surgical and seriously injured patients. Under physiological conditions activators and inhibitors of coagulation regulate the sensitive balance between clot formation and fibrinolysis. In some cases, excessive and diffuse bleeding is caused by systemic activation of fibrinolysis, i. e. hyperfibrinolysis (HF). Uncontrolled HF is associated with a high mortality. Polytrauma patients and those undergoing surgical procedures involving organs rich in plasminogen proactivators (e. g. liver, kidney, pancreas, uterus and prostate gland) are at a high risk for HF. Antifibrinolytics, such as tranexamic acid (TXA) are used for prophylaxis and treatment of bleeding caused by a local or generalized HF as well as other hemorrhagic conditions. TXA is a synthetic lysine analogue that has been available in Austria since 1966. TXA is of utmost importance in the prevention and treatment of traumatic and perioperative bleeding due to the resulting reduction in perioperative blood loss and blood transfusion requirements. The following article presents the different fields of application of TXA with particular respect to indications and dosages, based on a literature search and on current guidelines.

Highlights

Massive bleeding after surgical interventions or severe trauma continues to be one of the most frequent life-threatening emergencies [1,2,3]
In recent years interest has increasingly focused on intravenous administration, since it has been shown that early administration of tranexamic acid (TXA) after severe trauma can significantly increase the rate of survival [10,11,12,13]
The two guidelines for anticoagulation management published by the Society of Thoracic Surgeons (STS) and the European Association for Cardio-Thoracic Surgery (EACTS) deal with the intraoperative use of antifibrinolytics in heart surgery: both TXA and epsilon-aminocaproic acid (EACA) are consistently recommended to minimise blood loss and transfusion needs [1, 89]

Summary

Introduction

Massive bleeding after surgical interventions or severe trauma continues to be one of the most frequent life-threatening emergencies [1,2,3]. In recent years interest has increasingly focused on intravenous administration, since it has been shown that early administration of TXA after severe trauma can significantly increase the rate of survival [10,11,12,13]. HF is a state of increased clot resolution that may be associated with severe, potentially life-threatening hemorrhage. It may be caused by excessive plasmin formation or a reduction of plasmin decomposition due to a depletion of α2-antiplasmin. TXA inhibits fibrin cleavage, reducing the risk of hemorrhage. It blocks binding of α2-antiplasmin and inhibits inflammatory reactions.

Intravenous administration in general fibrinolysis

Results

Findings

Summary