Tranexamic acid (TXA) stabilizes clot formation by inhibiting fibrin degradation and improves postoperative outcomes. However, rare adverse events (e.g., thrombosis, seizures) warrant dose-risk evaluation. This study examines how perioperative blood loss and transfusion practices affect TXA concentrations during paediatric scoliosis surgery. Forty-three patients undergoing scoliosis surgery with TXA were retrospectively analysed. The study assessed the impact of packed red blood cell (PRBC) transfusion on plasma TXA levels and whether maintaining concentrations ≥10μg/mL correlated with intraoperative blood loss. TXA levels were measured using UHPLC-MS/MS. Median TXA concentration 30 min after the loading dose was 37.8μg/mL (IQR: 31.4-39.6μg/mL), decreasing to 10.6μg/mL (IQR: 9.7-13.5μg/mL) after transfusion. At surgery end, the mean concentration was 12.9 ± 2.5μg/mL. Thirty-one patients maintained TXA levels ≥10μg/mL, associated with ~80% inhibition of tissue plasminogen activator. Of six patients below this threshold, five had received transfusions. A significant correlation was found between higher intraoperative blood loss and lower TXA levels, consistent with a dilutional effect. In contrast, among patients with TXA ≥ 10μg/mL, correlation with blood loss was weak (Spearman's ρ = -0.11, p = 0.54). Findings suggest homologous PRBC transfusion reduces plasma TXA through volume expansion. Sustaining TXA concentrations >10μg/mL is essential for antifibrinolytic efficacy and haemostatic outcomes. The dilutional impact of PRBC transfusion underscores the need for intraoperative dose adjustment. Optimizing TXA dosing requires understanding pharmacokinetics and patient variability.

Pregnant persons with bleeding disorders (pwBD) have an increased risk of primary and secondary postpartum hemorrhage (PPH). Patients with von Willebrand disease, a bleeding disorder of unknown cause, or qualitative platelet defects (QPDs) and hemophilia carriers (HC) may or may not naturally achieve an adequately hemostatic state due to the hypercoagulable changes of pregnancy. PwBD greatly benefit from receiving care in a multidisciplinary setting including hematologists, obstetricians, anesthesiologists, and clinical geneticists. Factor levels should be obtained, at minimum, prior to conception as baseline as well as at the 34- to 36-week mark for delivery planning. However, target factor levels for delivery remain controversial given that many bleeding phenotypes do not predictably correlate with levels. Hemostatic therapies include antifibrinolytic agents, desmopressin, factor concentrates, and blood components such as cryoprecipitate, plasma, and platelets. Antifibrinolytics such as tranexamic acid have the most robust evidence for PPH management, though factor concentrates are now routinely utilized in certain circumstances. Blood products are an option for pwBD who have QPDs or when factor concentrates are not available. In patients with certain bleeding disorders, such as HCs, mode-of-delivery discussions must include consideration of the risks both to the affected neonate and to the mother. We favor selecting the mode of delivery based upon maternal indications whenever possible. Post partum, therapies may be continued for days or sometimes weeks after delivery, as pwBD are at high risk for delayed PPH.

Preoperative administration of tranexamic acid (TXA) reduces perioperative blood loss and transfusion requirements in total hip arthroplasty (THA), but optimal dosing remains uncertain due to the narrow range of doses explored in prior studies. This study aims to define the dose-response of intravenous TXA in THA, focusing on perioperative haemoglobin drop to improve blood-sparing effect. This monocentric, double-blind, placebo-controlled, parallel-group, dose-finding study will enrol 170 adults undergoing THA, aiming to randomise 150 patients. Participants will be allocated using a minimisation technique with a random component in equal proportions to receive either placebo or one of four intravenous TXA doses: 300 mg, 500 mg, 1000 mg or 3000 mg. Dose selection and sample size are based on a model-based meta-analysis that employed a maximum effect (Emax) model with a maximum effect of 40% and an ED50 (dose providing 50% of Emax) of 400 mg. The primary outcome will be the relative perioperative haemoglobin drop at postoperative day 3. Secondary outcomes include TXA exposure and perioperative fibrinolytic activity as measured by D-dimer levels. Only patients receiving the allocated study treatment will be analysed (modified intention-to-treat population). The dose-response relationship for the primary outcome will be analysed using non-linear mixed-effect models. The study protocol was approved by the French ethics committee (Institutional Review Board Sud Méditerranée V) and the French National Agency for the Safety of Medicines and Health Products (ANSM). Results will be disseminated at conferences and published in peer-reviewed journals. CTIS 2022-502532-38-01; NCT03822793.

Tranexamic acid in cutaneous oncology and cosmetic surgery: a comprehensive narrative review.

The effect of tranexamic acid on blood loss after surgical excision in burn patients.

The fibrinolytic system in disease: From molecular pathways to clinical outcomes.

PVA/pectin based electrospun nanofibers loaded with tranexamic acid for hemostasis: Preparation, in-vitro characterization, and in-vivo evaluation

Melasma is a common hyperpigmentary skin disorder. Because of its high prevalence and serious complications, including negative psychiatric effects, early diagnosis and treatment would be essential. This randomized, double-blind, case-controlled clinical trial compared the efficacy of niosomal tranexamic acid (TXA) 2%/niacinamide (NCA) 2% cream and conventional TXA 5%/NCA 4% cream with topical hydroquinone (HQ) 4% cream as a gold standard in melasma patients. A total of 99 patients were randomly assigned to three groups: Group A received niosomal TXA/NCA cream, Group B received conventional TXA/NCA cream, and Group C received HQ cream for three months. Each patient attended five dermatologist visits to evaluate clinical efficacy. All treatment groups showed a considerable reduction in melanin index and modified melasma area and severity index (mMASI) scores, as well as a notable improvement in patients’ quality of life. Although both niosomal TXA/NCA cream and conventional TXA/NCA cream were as effective as HQ cream in management of melasma, adverse reactions and relapse were observed in HQ group. Niosomal or conventional TXA/NCA creams are as effective as HQ 4% cream and due to less serious adverse reactions they would be better choices than HQ-containing preparations in hyperpigmentary disorders. Clinical Trial Registration No.: IRCT20220609055116N1 (Approval date: 07/23/2023).Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-26693-8.

Introduction . Bariatric surgery is a safe method of weight loss when performed in certified centers by surgeons who have completed the learning curve. However, there is still a risk of serious complications of bariatric operations. According to most studies, major bleeding is the main cause of increased postoperative morbidity and prolonged hospital stay. Aim . To evaluate the effectiveness and safety profile of tranexamic acid (TXA) in the prevention of bleeding after bariatric surgeries. Materials and methods . We analyzed medical records of all patients who underwent primary bariatric surgeries according to standard protocols. A total of 2,524 bariatric interventions were performed from 2016 to 2024. From 2016 to 2023, 1,983 operations were performed – a group of patients who did not routinely receive TXA intraoperatively. From January to December 2024, 541 surgical interventions were performed – a group of patients whose surgery ended with intravenous administration of 1,000 mg of TXA. Results . In the postoperative period, 32 cases of bleeding (1.6%) were registered in the group of patients where TXA was not used intraoperatively, whereas no no cases (0%) of major bleeding were observed in the group where TXA was used (0%; p = 0.0279). Intraluminal bleeding was recorded in 3 cases, all 3 cases were identified during Roux-en-Y gastric bypass. Conclusions . TXA is an effective complement to careful surgical technique for bariatric operations to reduce the risk of bleeding and improve outcomes due to its availability, cost-effectiveness, rapid onset of action, and systemic effect.

The direct anterior approach (DAA) is gaining use in total hip arthroplasty (THA), while the lateral approach (LA) remains standard. This study compared operative time, blood loss, implant positioning, and early complications in 200 patients (100 DAA, 100 LA). All procedures used cementless implants and tranexamic acid. Mean operative time was longer with DAA (87 vs. 76 minutes), but blood loss and transfusion rates were lower. Radiographs showed similar acetabular positioning; however, varus stem alignment and trochanteric fractures occurred more often with DAA. Early complications included one infection in DAA and three infections plus one dislocation in LA. At one month, Harris Hip Scores favored DAA (94 vs. 81). DAA facilitates faster recovery but requires careful technique and patient selection.

Tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) are antifibrinolytic agents commonly used to reduce blood loss in total knee arthroplasty (TKA). Although TXA is widely adopted, EACA offers a potentially more economical alternative. However, head-to-head comparisons using paired designs remain limited. The present randomized controlled trial included 294 patients undergoing bilateral TKA. Each patient received topical TXA in one knee and topical EACA in the contralateral knee in a randomized sequence. Primary outcomes included total perioperative blood loss and total drain output over 3 days. Secondary outcomes included transfusion requirement, postoperative complications, and cost-effectiveness. The statistical analyses included paired t-tests, linear mixed-effects models for effect modification, logistic regression for transfusion and complications, and cost-effectiveness analysis comparing drug costs against blood loss reduction. Data from 294 patients (588 knees) were analyzed. TXA was associated with a statistically significant but modest reduction in total blood loss compared with EACA (mean difference: 10.03 mL, p < 0.001), well below the predefined non-inferiority margin of 200 mL. Similarly, drain output was also found to be lower in TXA-treated knees (mean difference: 10.07 mL; p = 0.0001), but the difference was not considered clinically significant. The rates of transfusion and postoperative complications were low (2.72 and 3.74% respectively). Cost-effectiveness analysis revealed EACA to be more cost effective as compared with TXA. Topical EACA was found to be non-inferior to TXA in reducing perioperative blood loss in TKA, with equivalent clinical outcomes and greater cost-effectiveness. These findings support the use of EACA as a cost-saving alternative to TXA, particularly in resource-limited settings.

Background Intertrochanteric fractures (IFs) are a common type of fracture in the elderly and are often associated with substantial hidden blood loss (HBL) due to trauma and surgery. Tranexamic acid (TXA) has emerged as a potential intervention to reduce perioperative bleeding. This study aimed to evaluate the safety and efficacy of TXA administration in elderly patients with IFs undergoing intramedullary nailing, through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods Web of Science, Cochrane Library, Embase, and PubMed were searched for relevant RCTs published from inception to January 2025. Data on HBL, total blood loss (TBL), transfusion rate, and thromboembolic events were extracted. Review Manager 5.3.5 was used to assess the safety and efficacy of TXA. Results Eight RCTs involving 735 patients (363 in the TXA group and 372 in the control group) were included in the meta-analysis. The TXA group demonstrated significantly lower HBL [standard mean difference (SMD) = −0.59; 95% confidence interval (CI), −0.74 to −0.45] and TBL (SMD = −0.74; 95% CI, −0.91 to −0.58), as well as a reduced transfusion rate [relative risk (RR) = 0.50; 95% CI, 0.35–0.72] compared with the control group. Additionally, no significant difference in thromboembolic events was found between the two groups. Conclusions Current evidence indicates that TXA significantly reduces HBL and transfusion requirements without increasing the risk of thromboembolic events in elderly patients with IFs.

This study reviews the applications and effects of tranexamic acid in arthroscopic surgery. Bleeding during arthroscopic surgery is an important factor affecting surgical outcomes and postoperative recovery. Tranexamic acid is an anti fibrinolytic drug that can effectively inhibit fibrin degradation and may be helpful in reducing surgical bleeding and improving surgical field clarity. In this review, the pharmacological mechanism of tranexamic acid is first introduced, including its effect on the fibrinolytic system and its specific mechanism of action to reduce bleeding. Subsequently, the review describes the application of tranexamic acid in arthroscopic surgery, analyzes the safety of tranexamic acid in arthroscopic surgery, and related factors affecting the effectiveness of tranexamic in arthroscopic surgery. In addition, this review highlights future research directions regarding tranexamic acid in arthroscopic surgery. A comprehensive analysis of existing literature indicates that tranexamic acid has an impact on blood loss, pain, surgical time, surgical field clarity, and postoperative function during arthroscopic surgery. Therefore, the application of tranexamic acid in arthroscopic surgery has high clinical value and significance.

BackgroundTranexamic acid is an established drug in the treatment of bleeding trauma patients. Concerns have been raised over possible complications of tranexamic acid regarding thromboembolic events as serious complications during the treatment of severely injured patients.MethodsIn our study we retrospectively analyzed data from 2015—2019 of multiply injured patients receiving tranexamic acid during distinguished treatment periods from the TraumaRegister DGU®. We statistically analyzed overall thromboembolic complications during hospital stay in the context of number of single-dose tranexamic acid administrations.ResultsWe report on 37,342 patients, of whom 1,151 (3.1%) suffered from thromboembolic events. Patients without tranexamic acid treatment suffered from thromboembolic events in 2.3%, prehospital and emergency department administration increased the incidence to 4.8% and 5.2%, respectively. Administering tranexamic acid twice or three times was associated with an increased incidence of 8.5% and 8.2%, respectively. In a multivariate logistic regression, we uniquely show an independently associated risk for thromboembolic complications with every consecutive administration of tranexamic acid (one application: odds ratio (OR) 1.56, p < 0.001; two applications: OR 1.79, p < 0.001; three applications: OR 1.50, p = 0.113).ConclusionsIn our study we report on an associated risk of thromboembolic events in multiply injured patients with every single time tranexamic acid was administered in our study. Thus, before a repetitive dose of tranexamic acid is administered checking for indication is advised and especially in multiply injured patients receiving repeated administrations of TXA starting a thromboprophylaxis, as soon as possible after the traumatic bleeding disorder is controlled, is important.

The Effects of Tranexamic Acid on Renal Outcomes in Patients Undergoing Cardiovascular Surgery: A Systematic Review and Meta-Analysis Compliant With Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Use of Nebulized Tranexamic Acid to Reduce Epistaxis during Awake Nasotracheal Intubation: A Case Report

BackgroundTrauma remains a leading cause of death and disability in children. Effective initial assessment and structured management are vital to survival and recovery.ObjectivesTo present current principles of pediatric trauma care and highlight educational strategies that improve systematic assessment and intervention.ResultsEarly recognition of life-threatening conditions—catastrophic haemorrhage, severe head injury, airway obstruction, tension pneumothorax, massive hemothorax, flail chest, and cardiac tamponade—is critical. Immediate interventions such as airway stabilisation, tranexamic acid administration, massive haemorrhage protocol, chest decompression, and pelvic stabilisation can be lifesaving. Abdominal trauma requires prompt imaging and tailored surgical or conservative management. Head injury is the most common cause of pediatric trauma mortality; prevention of secondary brain injury through oxygenation, blood pressure control, ICP management, and timely neurosurgical intervention is essential. Cervical spine and spinal cord injury must always be suspected until excluded. Simulation-based training, adherence to protocols, and multidisciplinary coordination have demonstrated measurable benefits in team performance and patient outcomes.ConclusionsSystematic <C> ABCDE assessment, early targeted interventions, and structured training programs reduce preventable deaths in pediatric trauma. Head injury and haemorrhage remain the leading killers. Training and simulation improve clinician performance and outcomes. Education, focusing on rapid recognition, decision-making, and teamwork, bridges gaps between knowledge and practice.Key messages• Pediatric trauma care must follow a structured <C> ABCDE approach.• Life-threatening conditions require rapid, protocol-driven interventionsTopicPaediatric trauma, Life-threatening, Structured approach

This narrative vignette explores the perioperative management of a 65-year-old man scheduled for extended hindquarter amputation due to pelvic chondrosarcoma, with anticipated massive blood loss of 5-7 liters. Despite being otherwise fit, his preoperative hemoglobin of 125 g/L and low iron stores pose risks, prompting the clinical question: How should this patient be managed perioperatively to mitigate massive hemorrhage? Preoperative evaluation emphasises thorough assessment, including transfusion history, coagulopathy screening, and optimisation of pre-existing anemia via erythropoietin or intravenous iron, even in urgent oncological cases. Discontinuation of antiplatelets and anticoagulants requires balancing bleeding and thrombotic risks. Informed consent includes discussing morbidity such as organ failure and mortality. Intraoperatively, strategies include large-bore access, invasive monitoring, thromboelastography-guided transfusions, tranexamic acid to reduce fibrinolysis, and cell salvage where feasible. A multidisciplinary approach ensures communication between surgical teams, anaesthetic teams, nursinf staff and laboratories. Allogeneic transfusions should commence early to maintain stability, with vigilant monitoring for complications like hypothermia, hyperkalemia, and transfusion reactions. Postoperatively, ongoing surveillance in high-dependency care allows for assessement of further bleeding, and appropriate thromboprophylaxis.

An 18-year-old female was referred to the IALCH Neurology department with a one-week history of severe holocephalic headaches. The headaches were associated with diplopia to distant vision, bilateral tinnitus, transient visual obscurations and two episodes of vomiting. No seizures were reported. On medical history she reported irregular, heavy menses for the last three years. She was managed by her general practitioner and started on oral tranexamic acid (1000mg 12 hourly during menstruation) two days prior to the onset of the headaches. There was no history of oral contraceptive use, retinoids, recent illness or trauma. There was no history of recent COVID infection or vaccine. She had never been pregnant with no previous history to suggest miscarriage. There was no family history of note. On social history, she was a student with no history of cigarette smoking, alcohol or illicit substance use.

Melasma is a common, chronic, and recurrent pigmentation disorder caused by excessive melanin deposition in the epidermal and dermal layers of the skin. The treatment strategy for melasma presents a complex challenge, as it depends on the severity of the condition and the individual characteristics of the patient. One effective method for treating melasma is the combined use of laser therapy and the topical application of tranexamic acid, which has the property of reducing melanogenesis activity. Objective. To compare the efficacy and safety of melasma treatment using CO2-laser monotherapy versus a combination of laser therapy and the topical application of tranexamic acid. Materials and methods. The study included 20 patients, 10 of whom underwent three combined procedures of fractional photothermolysis using a CO2‑aser (10600 nm) followed by the application of a 5% tranexamic acid solution at 4‑week intervals. The other 10 patients received only the CO2‑laser procedure at the same intervals. Quantitative assessment methods included the Melasma Area and Severity Index (MASI), mexametry, and the Melasma Quality of Life scale (MELASQOL). Clinical evaluation was also performed using the «Antera» 3D skin imaging and diagnostic device. Conclusions. The use of a CO3‑laser followed by the application of a 5% tranexamic acid solution demonstrated greater effectiveness compared to laser therapy alone.