The many roles of tranexamic acid: An overview of the clinical indications for TXA in medical and surgical patients

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  • Johnny Cai
    Department of Internal Medicine Oregon Health and Science University Portland Oregon
  • Jessica Ribkoff
    School of Medicine Oregon Health and Science University Portland Oregon
  • Sven Olson
    Division of Hematology and Medical Oncology Knight Cancer Institute Oregon Health and Science University Portland Oregon
  • Vikram Raghunathan
    Division of Hematology and Medical Oncology Knight Cancer Institute Oregon Health and Science University Portland Oregon
  • Hanny Al‐Samkari
    Division of Hematology Massachusetts General Hospital Harvard Medical School Boston Massachusetts
  • Thomas G. DeLoughery
    Division of Hematology and Medical Oncology Knight Cancer Institute Oregon Health and Science University Portland Oregon
  • Joseph J. Shatzel
    Division of Hematology and Medical Oncology Knight Cancer Institute Oregon Health and Science University Portland Oregon

Abstract

<jats:title>Abstract</jats:title><jats:p>Clinically significant bleeding can occur as a consequence of surgery, trauma, obstetric complications, anticoagulation, and a wide variety of disorders of hemostasis. As the causes of bleeding are diverse and not always immediately apparent, the availability of a safe, effective, and non‐specific hemostatic agent is vital in a wide range of clinical settings, with antifibrinolytic agents often utilized for this purpose. Tranexamic acid (TXA) is one of the most commonly used and widely researched antifibrinolytic agents; its role in postpartum hemorrhage, menorrhagia, trauma‐associated hemorrhage, and surgical bleeding has been well defined. However, the utility of TXA goes beyond these common indications, with accumulating data suggesting its ability to reduce bleeding and improve clinical outcomes in the face of many different hemostatic challenges, without a clear increase in thrombotic risk. Herein, we review the literature and provide practical suggestions for clinical use of TXA across a broad spectrum of bleeding disorders.</jats:p>

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