What are the main benefits of Tranexamic Acid (TXA)?

From the Guidelines

Tranexamic acid is a crucial medication in reducing morbidity and mortality due to bleeding, and its main benefits include reducing blood loss in trauma patients, with a recommended dose of 1g infused over 10 min, followed by an i.v. infusion of 1g over 8 h, as soon as possible after injury 1. The medication works by inhibiting plasminogen activation, which stabilizes blood clots that have already formed, making it particularly useful in situations where there is increased fibrinolysis (breakdown of clots). Some of the key benefits of tranexamic acid include:

• Reducing blood loss during surgery
• Treating heavy menstrual bleeding
• Managing bleeding disorders
• Controlling bleeding in trauma patients The use of tranexamic acid has been supported by several studies, including the CRASH-2 trial, which demonstrated its effectiveness in reducing death, vascular occlusive events, and blood transfusion in trauma patients with significant hemorrhage 1. It is essential to note that tranexamic acid should be administered as soon as possible after injury, and its use should not await results from a viscoelastic assessment, as recommended by the European guideline on management of major bleeding and coagulopathy following trauma 1. In terms of side effects, tranexamic acid is generally well-tolerated, with mild side effects including nausea, vomiting, and diarrhea, but it should be used with caution in patients with a history of blood clots, as it could theoretically increase clotting risk, though this is rare at therapeutic doses.

From the FDA Drug Label

Tranexamic acid is an antifibrinolytic indicated in patients with hemophilia for short-term use (2 to 8 days) to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction. The main benefits of tranexamic acid are:

• Reduction of hemorrhage: Tranexamic acid reduces or prevents hemorrhage in patients with hemophilia.
• Reduction of need for replacement therapy: Tranexamic acid reduces the need for replacement therapy during and following tooth extraction in patients with hemophilia. 2, 2, 2

From the Research

Main Benefits of Tranexamic Acid

The main benefits of tranexamic acid include:

• Reduction of perioperative blood loss in various surgical procedures, such as cardiac surgery, total hip and knee replacement, and prostatectomy 3
• Decrease in transfusion requirements associated with surgery 3, 4
• Reduction of blood loss in gynaecological bleeding disorders, including heavy menstrual bleeding, postpartum haemorrhage, and bleeding irregularities caused by contraceptive implants 3, 5
• Reduction of all-cause mortality and death due to bleeding in trauma patients with significant bleeding, particularly when administered early after injury 3
• Effectiveness in traumatic hyphaema, gastrointestinal bleeding, and hereditary angioneurotic oedema 3
• Cost-effectiveness in surgery and trauma, with potential to be life-saving 3

Specific Benefits in Different Conditions

• In heavy menstrual bleeding, tranexamic acid reduces menstrual blood loss by 34-54% and improves patient quality of life by 46-83% 5
• In hip and femoral surgeries, tranexamic acid reduces postoperative blood loss and transfusion requirements 4
• In trauma patients, tranexamic acid reduces all-cause mortality and death due to bleeding, particularly when administered early after injury 3

Safety and Tolerability

• Tranexamic acid is generally well tolerated, with most adverse events being mild or moderate in severity 3
• No thromboembolic events were reported in studies analyzing the safety of tranexamic acid in patients with heavy menstrual bleeding 5