Tranexamic acid: Beyond antifibrinolysis

Authors

Igor Prudovsky, Maine Medical Center Research Institute, Maine Medical Center, Scarborough, Maine, USA.Follow
Doreen Kacer, Maine Medical Center Research Institute, Maine Medical Center, Scarborough, Maine, USA.Follow
Victoria Vieira Zucco, Maine Medical Center Research Institute, Maine Medical Center, Scarborough, Maine, USA.
Monica Palmeri, Maine Medical Center Cardiovascular Institute, Maine Medical Center, Portland, Maine, USA.Follow
Carolyne Falank, Department of Trauma, Maine Medical Center, Maine Medical Center, Portland, Maine, USA.Follow
Robert Kramer, Maine Medical Center Cardiovascular Institute, Maine Medical Center, Portland, Maine, USA.Follow
Damien Carter, Department of Trauma, Maine Medical Center, Maine Medical Center, Portland, Maine, USA.Follow
Joseph Rappold, Maine Medical Center Research Institute, Maine Medical Center, Scarborough, Maine, USA.Follow

Document Type

Article

Publication Date

7-14-2022

Institution/Department

Trauma & Acute Care Surgery

Journal Title

Transfusion

Abstract

Tranexamic acid (TXA) is a popular antifibrinolytic drug widely used in hemorrhagic trauma patients and cardiovascular, orthopedic, and gynecological surgical patients. TXA binds plasminogen and prevents its maturation to the fibrinolytic enzyme plasmin. A number of studies have demonstrated the broad life-saving effects of TXA in trauma, superior to those of other antifibrinolytic agents. Besides preventing fibrinolysis and blood loss, TXA has been reported to suppress posttraumatic inflammation and edema. Although the efficiency of TXA transcends simple inhibition of fibrinolysis, little is known about its mechanisms of action besides the suppression of plasmin maturation. Understanding the broader effects of TXA at the cell, organ, and organism levels are required to elucidate its potential mechanisms of action transcending antifibrinolytic activity. In this article, we provide a brief review of the current clinical use of TXA and then focus on the effects of TXA beyond antifibrinolytics such as its anti-inflammatory activity, protection of the endothelial and epithelial monolayers, stimulation of mitochondrial respiration, and suppression of melanogenesis.

Recommended Citation

Prudovsky I, Kacer D, Zucco VV, et al. Tranexamic acid: Beyond antifibrinolysis [published online ahead of print, 2022 Jul 14]. Transfusion. 2022;10.1111/trf.16976. doi:10.1111/trf.16976