PubMed

Abstract
Drugs.1999Jun57(6):100532.

Tranexamicacid:areviewofitsuseinsurgeryandotherindications.
DunnCJ1,GoaKL.

Authorinformation
Abstract
Tranexamicacidisasyntheticderivativeoftheaminoacidlysinethatexertsitsantifibrinolytic
effectthroughthereversibleblockadeoflysinebindingsitesonplasminogenmolecules.
Intravenouslyadministeredtranexamicacid(mostcommonly10mg/kgfollowedbyinfusionof1
mg/kg/hour)causedreductionsrelativetoplaceboof29to54%inpostoperativebloodlossesin
patientsundergoingcardiacsurgerywithcardiopulmonarybypass(CPB),withstatistically
significantreductionsintransfusionrequirementsinsomestudies.Tranexamicacidhadsimilar
efficacytoaprotinin2x10(6)kallikreininhibitoryunits(KIU)andwassuperiortodipyridamolein
thereductionofpostoperativebloodlosses.Transfusionrequirementswerereducedsignificantly
by43%withtranexamicacidandby60%withaprotininin1study.Metaanalysisof60trials
showedtranexamicacidandaprotinin,unlikeepsilonaminocaproicacid(EACA)and
desmopressin,toreducesignificantlythenumberofpatientsrequiringallogeneicblood
transfusionsaftercardiacsurgerywithCPB.Tranexamicacidwasassociatedwithreductions
relativetoplaceboinmortalityof5to54%inpatientswithuppergastrointestinalbleeding.Meta
analysisindicatedareductionof40%.Reductionsof34to57.9%versusplaceboorcontrolin
meanmenstrualbloodlossoccurredduringtranexamicacidtherapyinwomenwithmenorrhagia
thedrughasalsobeenusedtogoodeffectinplacentalbleeding,postpartumhaemorrhageand
conisationofthecervix.Tranexamicacidsignificantlyreducedmeanbloodlossesafteroral
surgeryinpatientswithhaemophiliaandwaseffectiveasamouthwashindentalpatients
receivingoralanticoagulants.Reductionsinbloodlosswerealsoobtainedwiththeuseofthe
druginpatientsundergoingorthotopiclivertransplantationortransurethralprostaticsurgery,and
ratesofrebleedingwerereducedinpatientswithtraumatichyphaema.Clinicalbenefithasalso
beenreportedwithtranexamicacidinpatientswithhereditaryangioneuroticoedema.
Tranexamicacidiswelltoleratednauseaanddiarrhoeaarethemostcommonadverseevents.
Increasedriskofthrombosiswiththedrughasnotbeendemonstratedinclinicaltrials.
CONCLUSIONS: Tranexamicacidisusefulinawiderangeofhaemorrhagicconditions.The
drugreducespostoperativebloodlossesandtransfusionrequirementsinanumberoftypesof
surgery,withpotentialcostandtolerabilityadvantagesoveraprotinin,andappearstoreduce
ratesofmortalityandurgentsurgeryinpatientswithuppergastrointestinalhaemorrhage.
Tranexamicacidreducesmenstrualbloodlossandisapossiblealternativetosurgeryin
menorrhagia,andhasbeenusedsuccessfullytocontrolbleedinginpregnancy.
PMID:10400410[PubMedindexedforMEDLINE]

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