Skip to main content
Log in

Tranexamic Acid

A Review of its Use in the Treatment of Hyperfibrinolysis

  • Adis Drug Evaluation
  • Published:
Drugs Aims and scope Submit manuscript

Abstract

Tranexamic acid, a synthetic derivative of the amino acid lysine, is an antifibrinolytic agent that acts by binding to plasminogen and blocking the interaction of plasmin (ogen) with fibrin, thereby preventing dissolution of the fibrin clot. Tranexamic acid (Transamin®) is indicated in Japan for use in certain conditions with abnormal bleeding or bleeding tendencies in which local or systemic hyperfi-brinolysis is considered to be involved. This article reviews the efficacy and tolerability of tranexamic acid in conditions amenable to antifibrinolytic therapy and briefly overviews the pharmacological properties of the drug.

In large, randomized controlled trials, tranexamic acid generally significantly reduced perioperative blood loss compared with placebo in a variety of surgical procedures, including cardiac surgery with or without cardiopulmonary bypass, total hip and knee replacement and prostatectomy. In many instances, tranexamic acid also reduced transfusion requirements associated with surgery. It also reduced blood loss in gynaecological bleeding disorders, such as heavy menstrual bleeding, postpartum haemorrhage and bleeding irregularities caused by contraceptive implants. Tranexamic acid significantly reduced all-cause mortality and death due to bleeding in trauma patients with significant bleeding, particularly when administered early after injury. It was also effective in traumatic hyphaema, gastrointestinal bleeding and hereditary angioneurotic oedema. While it reduces rebleeding in subarachnoid haemorrhage, it may increase ischaemic complications. Pharmacoeconomic analyses predicted that tranexamic acid use in surgery and trauma would be very cost effective and potentially life saving.

In direct comparisons with other marketed agents, tranexamic acid was at least as effective as e-aminocaproic acid and more effective than desmopressin in surgical procedures. It was more effective than desmopressin, etamsylate, flurbiprofen, mefenamic acid and norethisterone, but less effective than the levonorgestrel-releasing intra-uterine device in heavy menstrual bleeding and was as effective as prednisolone in traumatic hyphaema.

Tranexamic acid was generally well tolerated. Most adverse events in clinical trials were of mild or moderate severity; severe or serious events were rare. Therefore, while high-quality published evidence is limited for some approved indications, tranexamic acid is an effective and well tolerated antifibrinolytic agent.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Table I
Table II
Table III
Table IV
Table V
Table VI
Table VII
Table VIII

Similar content being viewed by others

References

  1. Merck & Co. Merck Manual Online: overview of hemostasis [online]. Available from URL: http://www.merckmanuals.com/professional/hematology_and_oncology/hemostasis/overview_of_hemostasis.html [Accessed 2012 Feb 23]

  2. Fergusson DA, Hébert PC, Mazer CD, et al. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med 2008 May 29; 358(22): 2319–31

    PubMed  CAS  Google Scholar 

  3. Hunt BJ, Segal H. Hyperfibrinolysis. J Clin Pathol 1996 Dec; 49(12): 958

    PubMed Central  PubMed  CAS  Google Scholar 

  4. Ferring Pharmaceuticals Inc. Lysteda (tranexamic acid) tablets: US prescribing information [online]. Available from URL: http://lysteda.com/assets/pdf/PI_FERRING2010.pdf [Accessed 2012 Feb 23]

  5. Pfizer. Cyklokapron® (tranexamic acid injection): US prescribing information [online]. Available from URL: http://labeling.pfizer.com/ShowLabeling.aspx?id=556 [Accessed 2012 Feb 23]

  6. Transamin® (tranexamic acid) injection 5%, 10%: Japanese prescribing information. Tokyo: Daiichi Pharmaceutical Co., Ltd, 2005

  7. Transamin® (tranexamic acid) capsules, tablets 250 & 500 mg, powder 50%: Japanese prescribing information. Tokyo: Daiichi Pharmaceutical Co., Ltd, 2005

  8. Electronic Medicines Compendium. Cyklokapron tablets: summary of product characteristics [online]. Available from URL: http://www.medicines.org.uk/EMC/medicine/16512/SPC/Cyklokapron+Tablets/ [Accessed 2012 Feb 23]

  9. Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999 Jun; 57(6): 1005–32

    PubMed  CAS  Google Scholar 

  10. Anonick PK, Vasudevan J, Gonias SL. Antifibrinolytic activities of α-N-acetyl-L-lysine methyl ester, e-aminocaproic acid, and tranexamic acid; importance of kringle interactions and active site inhibition. Arterioscler Thromb 1992 Jun; 12(6): 708–16

    PubMed  CAS  Google Scholar 

  11. Sperzel M, Huetter J. Evaluation of aprotinin and tranexamic acid in different in vitro and in vivo models of fibrinolysis, coagulation and thrombus formation. J Thromb Haemost 2007; 5(10): 2113–8

    PubMed  CAS  Google Scholar 

  12. Dirkmann D, Gorlinger K, Gisbertz C, et al. Factor XIII and tranexamic acid but not recombinant factor VIIa attenuate tissue plasminogen activator-induced hyperfibrinolysis in human whole blood. Anesth Analg. Epub 2011 Nov 21

  13. Reust DL, Reeves ST, Abernathy 3rd JH, et al. Temporally and regionally disparate differences in plasmin activity by tranexamic acid. Anesth Analg 2010 Mar 1; 110(3): 694–701

    PubMed Central  PubMed  CAS  Google Scholar 

  14. Jimenez JJ, Iribarren JL, Lorente L, et al. Tranexamic acid attenuates inflammatory response in cardiopulmonary bypass surgery through blockade of fibrinolysis: a case control study followed by a randomized double-blind controlled trial. Crit Care 2007; 11(6): R117

    PubMed Central  PubMed  Google Scholar 

  15. Schlag MG, Hopf R, Zifko U, et al. Epileptic seizures following cortical application of fibrin sealants containing tranexamic acid in rats. Acta Neurochir 2002; 144(1): 63–9

    PubMed  CAS  Google Scholar 

  16. Schlag MG, Hopf R, Redl H. Convulsive seizures following subdural application of fibrin sealant containing tranexamic acid in a rat model. Neurosurgery 2000 Dec; 47(6): 1463–7

    PubMed  CAS  Google Scholar 

  17. Pellegrini A, Giaretta D, Chemello R, et al. Feline generalized epilepsy induced by tranexamic acid (AMCA). Epilepsia 1982 Feb; 23(1): 35–45

    PubMed  CAS  Google Scholar 

  18. Furtmüller R, Schlag MG, Berger M, et al. Tranexamic acid, a widely used antifibrinolytic agent, causes convulsions by a γ-aminobutyric acidA receptor antagonistic effect. J Pharmacol Exp Ther 2002 Apr; 301(1): 168–73

    PubMed  Google Scholar 

  19. Kaabachi O, Eddhif M, Rais K, et al. Inadvertent intrathecal injection of tranexamic acid. Saudi J Anaesth 2011 Jan; 5(1): 90–2

    PubMed Central  PubMed  Google Scholar 

  20. Mohseni K, Jafari A, Nobahar MR, et al. Polymyoclonus seizure resulting from accidental injection of tranexamic acid in spinal anesthesia. Anesth Analg 2009 Jun; 108(6): 1984–6

    PubMed  CAS  Google Scholar 

  21. Yeh HM, Lau HP, Lin PL, et al. Convulsions and refractory ventricular fibrillation after intrathecal injection of a massive dose of tranexamic acid. Anesthesiology 2003 Jan; 98(1): 270–2

    PubMed  Google Scholar 

  22. Benoni G, Björkman S, Fredin H. Application of pharm-acokinetic data from healthy volunteers for the prediction of plasma concentrations of tranexamic acid in surgical patients. Clin Drug Invest 1995 Nov; 10(5): 280–7

    CAS  Google Scholar 

  23. Fiechtner BK, Nuttall GA, Johnson ME, et al. Plasma tranexamic acid concentrations during cardiopulmonary bypass. Anesth Analg 2001; 92(5): 1131–6

    PubMed  CAS  Google Scholar 

  24. Pilbrant Å, Schannong M, Vessman J. Pharmacokinetics and bioavailability of tranexamic acid. Eur J Clin Pharmacol 1981; 20(1): 65–72

    PubMed  CAS  Google Scholar 

  25. Dowd NP, Karski JM, Cheng DC, et al. Pharmacokinetics of tranexamic acid during cardiopulmonary bypass. Anesthesiology 2002 Aug; 97(2): 390–9

    PubMed  CAS  Google Scholar 

  26. Woodman RC, Harker LA. Bleeding complications associated with cardiopulmonary bypass. Blood 1990 Nov 1; 76(9): 1680–97

    PubMed  CAS  Google Scholar 

  27. Katsaros D, Petricevic M, Snow NJ, et al. Tranexamic acid reduces postbypass blood use: a double-blinded, prospective, randomized study of 210 patients. Ann Thorac Surg 1996; 61(4): 1131–5

    PubMed  CAS  Google Scholar 

  28. Mehr-Aein A, Davoodi S, Madani-Civi M. Effects of tranexamic acid and autotransfusion in coronary artery bypass. Asian Cardiovasc Thorac Ann 2007; 15(1): 49–53

    PubMed  Google Scholar 

  29. Maddali MM, Rajakumar MC. Tranexamic acid and primary coronary artery bypass surgery: a prospective study. Asian Cardiovasc Thorac Ann 2007; 15(4): 313–9

    PubMed  Google Scholar 

  30. Hekmat K, Zimmermann T, Kampe S, et al. Impact of tranexamic acid vs. aprotinin on blood loss and transfusion requirements after cardiopulmonary bypass: a prospective, randomised, double-blind trial. Curr Med Res Opin 2004; 20(1): 121–6

    CAS  Google Scholar 

  31. Özal E, Kuralay E, Bingöl H, et al. Does tranexamic acid reduce desmopressin-induced hyperfibrinolysis? J Thorac Cardiovasc Surg 2002; 123(3): 539–43

    PubMed  Google Scholar 

  32. Casati V, Guzzon D, Oppizzi M, et al. Hemostatic effects of aprotinin, tranexamic acid and e-aminocaproic acid in primary cardiac surgery. Ann Thorac Surg 1999; 68(6): 2252–7

    PubMed  CAS  Google Scholar 

  33. Later AFL, Maas JJ, Engbers FHM, et al. Tranexamic acid and aprotinin in low- and intermediate-risk cardiac surgery: a non-sponsored, double-blind, randomised, placebo-controlled trial. Eur J Cardio-Thorac Surg 2009; 36(2): 322–9

    Google Scholar 

  34. Dietrich W, Spannagl M, Boehm J, et al. Tranexamic acid and aprotinin in primary cardiac operations: an analysis of 220 cardiac surgical patients treated with tranexamic acid or aprotinin. Anesth Analg 2008; 107(5): 1469–78

    PubMed  Google Scholar 

  35. Murphy GJ, Mango E, Lucchetti V, et al. A randomized trial of tranexamic acid in combination with cell salvage plus a meta-analysis of randomized trials evaluating tranexamic acid in off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 2006; 132(3): 475–80.e8

    PubMed  CAS  Google Scholar 

  36. Casati V, Guzzon D, Oppizzi M, et al. Tranexamic acid compared with high-dose aprotinin in primary elective heart operations: effects on perioperative bleeding and allogeneic transfusions. J Thorac Cardiovasc Surg 2000; 120(3): 520–7

    PubMed  CAS  Google Scholar 

  37. Shimizu K, Toda Y, Iwasaki T, et al. Effect of tranexamic acid on blood loss in pediatric cardiac surgery: a randomized trial. J Anesth 2011 Dec; 25(6): 823–30

    PubMed  Google Scholar 

  38. Casati V, Sandrelli L, Speziali G, et al. Hemostatic effects of tranexamic acid in elective thoracic aortic surgery: a prospective, randomized, double-blind, placebo-controlled study. J Thorac Cardiovasc Surg 2002; 123(6): 1084–91

    PubMed  CAS  Google Scholar 

  39. Zabeeda D, Medalion B, Sverdlov M, et al. Tranexamic acid reduces bleeding and the need for blood transfusion in primary myocardial revascularization. Ann Thorac Surg 2002; 74(3): 733–8

    PubMed  Google Scholar 

  40. Dryden PJ, O’Connor JP, Jamieson WR, et al. Tranexamic acid reduces blood loss and transfusion in reoperative cardiac surgery. Can J Anaesth 1997 Sep; 44(9): 934–41

    PubMed  CAS  Google Scholar 

  41. Santos ATL, Kalil RAK, Bauemann C, et al. A randomized, double-blind, and placebo-controlled study with tranexamic acid of bleeding and fibrinolytic activity after primary coronary artery bypass grafting. Braz J Med Biol Res 2006; 39(1): 63–9

    PubMed  CAS  Google Scholar 

  42. Brown RS, Thwaites BK, Mongan PD. Tranexamic acid is effective in decreasing postoperative bleeding and transfusions in primary coronary artery bypass operations: a double-blind, randomized, placebo-controlled trial. Anesth Analg 1997 Nov; 85(5): 963–70

    PubMed  CAS  Google Scholar 

  43. Coffey A, Pittmam J, Halbrook H, et al. The use of tranexamic acid to reduce postoperative bleeding following cardiac surgery: a double-blind randomized trial. Am Surg 1995 Jul; 61(7): 566–8

    PubMed  CAS  Google Scholar 

  44. Hardy JF, Bélisle S, Dupont C, et al. Prophylactic tranexamic acid and epsilon-aminocaproic acid for primary myocardial revascularization. Ann Thorac Surg 1998 Feb; 65(2): 371–6

    PubMed  CAS  Google Scholar 

  45. Horrow JC, Hlavacek J, Strong MD, et al. Prophylactic tranexamic acid decreases bleeding after cardiac operations. J Thorac Cardiovasc Surg 1990 Jan; 99(1): 70–4

    PubMed  CAS  Google Scholar 

  46. Horrow JC, Van Riper DF, Strong MD, et al. Hemostatic effects of tranexamic acid and desmopressin during cardiac surgery. Circulation 1991 Nov; 84(5): 2063–70

    PubMed  CAS  Google Scholar 

  47. Horrow JC, Van Riper DF, Strong MD, et al. The dose-response relationship of tranexamic acid. Anesthesiology 1995 Feb; 82(2): 383–92

    PubMed  CAS  Google Scholar 

  48. Shore-Lesserson L, Reich DL, Vela-Cantos F, et al. Tranexamic acid reduces transfusions and mediastinal drainage in repeat cardiac surgery. Anesth Analg 1996 Jul; 83(1): 18–26

    PubMed  CAS  Google Scholar 

  49. Andreasen JJ, Nielsen C. Prophylactic tranexamic acid in elective, primary coronary artery bypass surgery using cardiopulmonary bypass. Eur J Cardio-Thorac Surg 2004; 26(2): 311–7

    Google Scholar 

  50. Casati V, Bellotti F, Gerli C, et al. Tranexamic acid administration after cardiac surgery: a prospective, randomized, double-blind, placebo-controlled study. Anesthesiology 2001; 94(1): 8–14

    PubMed  CAS  Google Scholar 

  51. Kuitunen A, Hiippala S, Vahtera E, et al. The effects of aprotinin and tranexamic acid on thrombin generation and fibrinolytic response after cardiac surgery. Acta Anaesthesiol Scand 2005; 49(9): 1272–9

    PubMed  CAS  Google Scholar 

  52. Corbeau JJ, Monrigal JP, Jacob JP, et al. Comparison of effects of aprotinin and tranexamic acid on blood loss in heart surgery [in French]. Ann Fr Anesth Reanim 1995; 14(2): 154–61

    PubMed  CAS  Google Scholar 

  53. Menichetti A, Tritapepe L, Ruvolo G, et al. Changes in coagulation patterns, blood loss and blood use after cardiopulmonary bypass: aprotinin vs tranexamic acid vs epsilon aminocaproic acid. J Cardiovasc Surg (Torino) 1996 Aug; 37(4): 401–7

    CAS  Google Scholar 

  54. Pugh SC, Wielogorski AK. A comparison of the effects of tranexamic acid and low-dose aprotinin on blood loss and homologous blood usage in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 1995 Jun; 9(3): 240–4

    PubMed  CAS  Google Scholar 

  55. Speekenbrink RG, Vonk AB, Wildevuur CR, et al. Hemostatic efficacy of dipyridamole, tranexamic acid, and aprotinin in coronary bypass grafting. Ann Thorac Surg 1995 Feb; 59(2): 438–42

    PubMed  CAS  Google Scholar 

  56. Blauhut B, Harringer W, Bettelheim P, et al. Comparison of the effects of aprotinin and tranexamic acid on blood loss and related variables after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1994 Dec; 108(6): 1083–91

    PubMed  CAS  Google Scholar 

  57. Penta de Peppo A, Pierri MD, Scafuri A, et al. Intraoperative antifibrinolysis and blood-saving techniques in cardiac surgery: prospective trial of 3 antifibrinolytic drugs. Tex Heart Inst J 1995; 22(3): 231–6

    PubMed Central  PubMed  CAS  Google Scholar 

  58. Wong J, El Beheiry H, Rampersaud YR, et al. Tranexamic acid reduces perioperative blood loss in adult patients having spinal fusion surgery. Anesth Analg 2008; 107(5): 1479–86

    PubMed  Google Scholar 

  59. Pleym H, Stenseth R, Wahba A, et al. Single-dose tranexamic acid reduces postoperative bleeding after coronary surgery in patients treated with aspirin until surgery. Anesth Analg 2003; 96(4): 923–8

    PubMed  CAS  Google Scholar 

  60. Bernet F, Carrel T, Marbet G, et al. Reduction of blood loss and transfusion requirements after coronary artery bypass grafting: similar efficacy of tranexamic acid and aprotinin in aspirin-treated patients. J Card Surg 1999; 14(2): 92–7

    PubMed  CAS  Google Scholar 

  61. Cheng DC, Bainbridge D, Martin JE, et al. Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology 2005 Jan; 102(1): 188–203

    PubMed  Google Scholar 

  62. Vanek T, Jares M, Fajt R, et al. Fibrinolytic inhibitors in off-pump coronary surgery: a prospective, randomized, double-blind TAP study (tranexamic acid, aprotinin, placebo). Eur J Cardio-Thorac Surg 2005; 28(4): 563–8

    Google Scholar 

  63. Mehr-Aein A, Sadeghi M, Madani-Civi M. Does tranexamic acid reduce blood loss in off-pump coronary artery bypass? Acta Med Iran 2006; 44(5): 309–15

    Google Scholar 

  64. Casati V, Gerli C, Franco A, et al. Tranexamic acid in off-pump coronary surgery: a preliminary, randomized, double-blind, placebo-controlled study. Ann Thorac Surg 2001; 72(2): 470–5

    PubMed  CAS  Google Scholar 

  65. Ahn SW, Shim JK, Youn YN, et al. Effect of tranexamic acid on transfusion requirement in dual antiplatelet-treated anemic patients undergoing off-pump coronary artery bypass graft surgery: a randomized controlled study. Circ J 2012 Jan; 76(1): 96–101

    PubMed  CAS  Google Scholar 

  66. Casati V, Della Valle P, Benussi S, et al. Effects of tranexamic acid on postoperative bleeding and related hematochemical variables in coronary surgery: comparison between on-pump and off-pump techniques. J Thorac Cardiovasc Surg 2004; 128(1): 83–91

    PubMed  CAS  Google Scholar 

  67. Fawzy H, Elmistekawy E, Bonneau D, et al. Can local application of tranexamic acid reduce post-coronary bypass surgery blood loss? A randomized controlled trial. J Cardiothorac Surg 2009 Jun 18; 4: 25

    PubMed Central  PubMed  Google Scholar 

  68. De Bonis M, Cavaliere F, Alessandrini F, et al. Topical use of tranexamic acid in coronary artery bypass operations: a double-blind, prospective, randomized, placebo-controlled study. J Thorac Cardiovasc Surg 2000; 119(3): 575–80

    PubMed  Google Scholar 

  69. Abul-Azm A, Abdullah KM. Effect of topical tranexamic acid in open heart surgery. Eur J Anaesthesiol 2006; 23(5): 380–4

    PubMed  CAS  Google Scholar 

  70. Kurt T. Evaluation of the effects of systemic or topical use of tranexamic acid and aprotinin on the blood loss and the used amount of blood products following cardiopul-monary bypass surgery [in Turkish]. Anatolian J Clin Invest 2011; 5(3): 116–21

    Google Scholar 

  71. Baric D, Biocina B, Unic D, et al. Topical use of antifibrinolytic agents reduces postoperative bleeding: a double-blind, prospective, randomized study. Eur J Cardiothorac Surg 2007 Mar; 31(3): 366–71

    PubMed  Google Scholar 

  72. Ngaage DL, Bland JM. Lessons from aprotinin: is the routine use and inconsistent dosing of tranexamic acid prudent? Meta-analysis of randomised and large matched observational studies. Eur J Cardio-Thorac Surg 2010; 37(6): 1375–83

    Google Scholar 

  73. Chauhan S, Bisoi A, Kumar N, et al. Dose comparison of tranexamic acid in pediatric cardiac surgery. Asian Cardiovasc Thorac Ann 2004; 12(2): 121–4

    PubMed  Google Scholar 

  74. Klenerman L, Chakrabarti R, Mackie I, et al. Changes in haemostatic system after application of a tourniquet. Lancet 1977 May 7; 1(8019): 970–2

    PubMed  CAS  Google Scholar 

  75. Zufferey PJ, Miquet M, Quenet S, et al. Tranexamic acid in hip fracture surgery: a randomized controlled trial. Br J Anaesth 2010; 104(1): 23–30

    PubMed  CAS  Google Scholar 

  76. Camarasa MA, Ollé G, Serra-Prat M, et al. Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: a randomized clinical trial. Br J Anaesth 2006; 96(5): 576–82

    PubMed  CAS  Google Scholar 

  77. Ishida K, Tsumura N, Kitagawa A, et al. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop 2011 Nov; 35(11): 1639–45

    PubMed Central  PubMed  Google Scholar 

  78. Wong J, Abrishami A, El Beheiry H, et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Jt Surg Ser A 2010; 92(15): 2503–13

    Google Scholar 

  79. Onodera T, Majima T, Sawaguchi N, et al. Risk of deep venous thrombosis in drain clamping with tranexamic acid and carbazochrome sodium sulfonate hydrate in total knee arthroplasty. J Arthroplasty 2012 Jan; 27(1): 105–8

    PubMed  Google Scholar 

  80. Charoencholvanich K, Siriwattanasakul P. Tranexamic acid reduces blood loss and blood transfusion after TKA: a prospective randomized controlled trial. Clin Orthop Relat Res 2011; 469(10): 2874–80

    PubMed Central  PubMed  Google Scholar 

  81. Kazemi SM, Mosaffa F, Eajazi A, et al. The effect of tranexamic acid on reducing blood loss in cementless total hip arthroplasty under epidural anesthesia. Orthopedics 2010; 33(1): 17

    PubMed  Google Scholar 

  82. Sadeghi M, Mehr-Aein A. Does a single bolus dose of tranexamic acid reduce blood loss and transfusion requirements during hip fracture surgery? A prospective randomized double blind study in 67 patients. Acta Med Iran 2007; 45(6): 437–42

    CAS  Google Scholar 

  83. Johansson T, Pettersson L-G, Lisander B. Tranexamic acid in total hip arthroplasty saves blood and money: a randomized, double-blind study in 100 patients. Acta Orthop 2005; 76(3): 314–9

    PubMed  Google Scholar 

  84. Hiippala ST, Strid LJ, Wennerstrand MI, et al. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg 1997; 84(4): 839–44

    PubMed  CAS  Google Scholar 

  85. Benoni G, Fredin H. Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: a prospective, randomised, double-blind study of 86 patients. J Bone Joint Surg Br 1996 May; 78(3): 434–40

    PubMed  CAS  Google Scholar 

  86. Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth 2003; 90(5): 596–9

    PubMed  CAS  Google Scholar 

  87. Jansen AJ, Andreica S, Claeys M, et al. Use of tranexamic acid for an effective blood conservation strategy after total knee arthroplasty. Br J Anaesth 1999; 83(4): 596–601

    PubMed  CAS  Google Scholar 

  88. MacGillivray RG, Tarabichi SB, Hawari MF, et al. Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty: a prospective, randomized double blind study. J Arthroplasty 2011; 26(1): 24–8

    PubMed  Google Scholar 

  89. Veien M, Sørensen JV, Madsen F, et al. Tranexamic acid given intraoperatively reduces blood loss after total knee replacement: a randomized, controlled study. Acta Anaesthesiol Scand 2002; 46(10): 1206–11

    PubMed  CAS  Google Scholar 

  90. Zohar E, Ellis M, Ifrach N, et al. The postoperative blood-sparing efficacy of oral versus intravenous tranexamic acid after total knee replacement. Anesth Analg 2004; 99(6): 1679–83

    PubMed  Google Scholar 

  91. Benoni G, Fredin H, Knebel R, et al. Blood conservation with tranexamic acid in total hip arthroplasty: a randomized, double-blind study in 40 primary operations. Acta Orthop Scand 2001; 72(5): 442–8

    PubMed  CAS  Google Scholar 

  92. Claeys MA, Vermeersch N, Haentjens P. Reduction of blood loss with tranexamic acid in primary total hip replacement surgery. Acta Chir Belg 2007; 107(4): 397–401

    PubMed  CAS  Google Scholar 

  93. Ekbäck G, Axelsson K, Ryttberg L, et al. Tranexamic acid reduces blood loss in total hip replacement surgery. Anesth Analg 2000; 91(5): 1124–30

    PubMed  Google Scholar 

  94. Husted H, Blønd L, Sonne-Holm S, et al. Tranexamic acid reduces blood loss and blood transfusions in primary total hip arthroplasty: a prospective randomized double-blind study in 40 patients. Acta Orthop Scand 2003; 74(6): 665–9

    PubMed  Google Scholar 

  95. Niskanen RO, Korkala OL. Tranexamic acid reduces blood loss in cemented hip arthroplasty: a randomized, double-blind study of 39 patients with osteoarthritis. Acta Orthop 2005; 76(6): 829–32

    PubMed  Google Scholar 

  96. McConnell JS, Shewale S, Munro NA, et al. Reduction of blood loss in primary hip arthroplasty with tranexamic acid or fibrin spray: a randomized controlled trial. Acta Orthop 2011 Dec; 82(6): 660–3

    PubMed Central  PubMed  Google Scholar 

  97. Lemay E, Guay J, Cóté C, et al. Tranexamic acid reduces the need for allogenic red blood cell transfusions in patients undergoing total hip replacement. Can J Anesth 2004; 51(1): 31–7

    PubMed  Google Scholar 

  98. Orpen NM, Little C, Walker G, et al. Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomised controlled trial of 29 patients. Knee 2006; 13(2): 106–10

    PubMed  Google Scholar 

  99. Benoni G, Lethagen S, Nilsson P, et al. Tranexamic acid, given at the end of the operation, does not reduce postoperative blood loss in hip arthroplasty. Acta Orthop Scand 2000; 71(3): 250–4

    PubMed  CAS  Google Scholar 

  100. Zufferey P, Merquiol F, Laporte S, et al. Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery? Anesthesiology 2006 Nov; 105(5): 1034–46

    PubMed  Google Scholar 

  101. Zhang H, Chen J, Chen F, et al. The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. Epub 2011 Nov 8

  102. Sukeik M, Alshryda S, Haddad FS, et al. Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Jt Surg Ser B 2011; 93B(1): 39–46

    Google Scholar 

  103. Mannucci PM, Levi M. Prevention and treatment of major blood loss. N Engl J Med 2007 May 31; 356(22): 2301–11

    PubMed  CAS  Google Scholar 

  104. Elwatidy S, Jamjoom Z, Elgamal E, et al. Efficacy and safety of prophylactic large dose of tranexamic acid in spine surgery: a prospective, randomized, double-blind, placebo-controlled study. Spine 2008; 33(24): 2577–80

    PubMed  Google Scholar 

  105. Farrokhi MR, Kazemi AP, Eftekharian HR, et al. Efficacy of prophylactic low dose of tranexamic acid in spinal fixation surgery: a randomized clinical trial. J Neurosurg Anesthesiol 2011; 23(4): 290–6

    PubMed  Google Scholar 

  106. Tsutsumimoto T, Shimogata M, Ohta H, et al. Tranexamic acid reduces perioperative blood loss in cervical laminoplasty: a prospective randomized study. Spine 2011; 36(23): 1913–8

    PubMed  Google Scholar 

  107. Taghaddomi RJ, Mashhadinezhad H, Attar ARS, et al. The effect of intravenous tranexamic acid on blood loss in lumbar hernial disc resection under inhalation and total intravenous anesthesia. Iran Red Crescent MedJ 2009; 11(3): 265–70

    Google Scholar 

  108. Sethna NF, Zurakowski D, Brustowicz RM, et al. Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery. Anesthesiology 2005; 102(4): 727–32

    PubMed  CAS  Google Scholar 

  109. Neilipovitz DT, Murto K, Hall L, et al. A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg 2001; 93(1): 82–7

    PubMed  CAS  Google Scholar 

  110. Dadure C, Sauter M, Bringuier S, et al. Intraoperative tranexamic acid reduces blood transfusion in children undergoing craniosynostosis surgery: a randomized double-blind study. Anesthesiology 2011; 114(4): 856–61

    PubMed  CAS  Google Scholar 

  111. Goobie SM, Meier PM, Pereira LM, et al. Efficacy of tranexamic acid in pediatric craniosynostosis surgery: a double-blind, placebo-controlled trial. Anesthesiology 2011; 114(4): 862–71

    PubMed  CAS  Google Scholar 

  112. Caglar GS, Tasci Y, Kayikcioglu F, et al. Intravenous tranexamic acid use in myomectomy: a prospective randomized double-blind placebo controlled study. Eur J Obstet Gynecol Reprod Biol 2008; 137(2): 227–31

    PubMed  CAS  Google Scholar 

  113. Crescenti A, Borghi G, Bignami E, et al. Intraoperative use of tranexamic acid to reduce transfusion rate in patients undergoing radical retropubic prostatectomy: double blind, randomised, placebo controlled trial. BMJ 2011 Oct 19; 343: d5701

    PubMed Central  PubMed  Google Scholar 

  114. Rannikko A, Pétas A, Taari K. Tranexamic acid in control of primary hemorrhage during transurethral prostatectomy. Urology 2004; 64(5): 955–8

    PubMed  Google Scholar 

  115. Chhapola S, Matta I. Short-term use of tranexamic acid to reduce blood loss in endoscopic nasal surgeries. Clinical Rhinology 2011; 4(2): 79–81

    Google Scholar 

  116. Wu C-C, Ho W-M, Cheng S-B, et al. Perioperative parenteral tranexamic acid in liver tumor resection: a prospective randomized trial toward “blood transfusion”-free hepatectomy. Ann Surg 2006; 243(2): 173–80

    PubMed Central  PubMed  Google Scholar 

  117. Dalmau A, Sabaté A, Acosta F, et al. Tranexamic acid reduces red cell transfusion better than e-aminocaproic acid or placebo in liver transplantation. Anesth Analg 2000; 91(1): 29–34

    PubMed  CAS  Google Scholar 

  118. Dalmau A, Sabaté A, Koo M, et al. The prophylactic use of tranexamic acid and aprotinin in orthotopic liver transplantation: a comparative study. Liver Transplant 2004; 10(2): 279–84

    Google Scholar 

  119. Hedlund PO. Antifibrinolytic therapy with Cyklokapron in connection with prostatectomy: a double blind study. Scand J Urol Nephrol 1969; 3(3): 177–82

    PubMed  CAS  Google Scholar 

  120. Kaufmann J, Siefker K. Reduction of post-prostatectomy bleeding by medication (experience with the antifibrinolytic agent AMCA) [in German]. Urologe 1969 Mar; 8(2): 57–9

    PubMed  CAS  Google Scholar 

  121. Boylan JF, Klinck JR, Sandler AN, et al. Tranexamic acid reduces blood loss, transfusion requirements, and coagulation factor use in primary orthotopic liver transplantation. Anesthesiology 1996 Nov; 85(5): 1043–8

    PubMed  CAS  Google Scholar 

  122. Kaspar M, Ramsay MAE, Nguyen A-T, et al. Continuous small-dose tranexamic acid reduces fibrinolysis but not transfusion requirements during orthotopic liver transplantation. Anesth Analg 1997 Aug; 85(2): 281–5

    PubMed  CAS  Google Scholar 

  123. Forbes CD, Barr RD, Reid G, et al. Tranexamic acid in control of haemorrhage after dental extraction in haemophilia and Christmas disease. Br Med J 1972 May 6; 2(5809): 311–3

    PubMed Central  PubMed  CAS  Google Scholar 

  124. Borea G, Montebugnoli L, Capuzzi P, et al. Tranexamic acid as a mouthwash in anticoagulant-treated patients undergoing oral surgery: an alternative method to discontinuing anticoagulant therapy. Oral Surg Oral Med Oral Pathol 1993 Jan; 75(1): 29–31

    PubMed  CAS  Google Scholar 

  125. Ramström G, Sindet-Pedersen S, Hall G, et al. Prevention of postsurgical bleeding in oral surgery using tranexamic acid without dose modification of oral anticoagulants. J Oral Maxillofac Surg 1993 Nov; 51(11): 1211–6

    PubMed  Google Scholar 

  126. Sindet-Pedersen S, Ramström G, Bernvil S, et al. Hemostatic effect of tranexamic acid mouthwash in anti-coagulant-treated patients undergoing oral surgery. N Engl J Med 1989 Mar 30; 320(13): 840–3

    PubMed  CAS  Google Scholar 

  127. Senghore N, Harris M. The effect of tranexamic acid (cyclokapron) on blood loss after third molar extraction under a day case general anaesthetic. Br Dent J 1999; 186(12): 634–6

    PubMed  CAS  Google Scholar 

  128. Lee APH, Boyle CA, Savidge GF, et al. Effectiveness in controlling haemorrhage after dental scaling in people with haemophilia by using tranexamic acid mouthwash. Brit Dent J 2005; 198(1): 33–8

    PubMed  CAS  Google Scholar 

  129. Jabalameli M, Zakeri K. Evaluation of topical tranexamic acid on intraoperative bleeding in endoscopic sinus surgery. Iran J Med Sci 2006; 31(4): 221–3

    Google Scholar 

  130. Kaewpradub P, Apipan B, Rummasak D. Does tranexamic acid in an irrigating fluid reduce intraoperative blood loss in orthognathic surgery? A double-blind, randomized clinical trial. J Oral Maxillofac Surg 2011; 69(6): e186–189

    PubMed  Google Scholar 

  131. Laatikainen L, Summanen P, Immonen I. Effect of tranexamic acid on postvitrectomy haemorrhage in diabetic patients. Int Ophthalmol 1987 Jun; 10(3): 153–5

    PubMed  CAS  Google Scholar 

  132. Ramezani AR, Ahmadieh H, Ghaseminejad AK, et al. Effect of tranexamic acid on early postvitrectomy diabetic haemorrhage: a randomised clinical trial. Br J Ophthalmol 2005; 89(8): 1041–4

    PubMed Central  PubMed  CAS  Google Scholar 

  133. Rybo G, Westerberg H. The effect of tranexamic acid (AMCA) on postoperative bleeding after conization. Acta Obstet Gynecol Scand 1972; 51(4): 347–50

    PubMed  CAS  Google Scholar 

  134. Landin L-E, Weiner E. Late bleeding after conization: the effect of tranexamic acid (Cyklokapron®). Opusc Med 1975; 20: 280–4

    Google Scholar 

  135. Liddell H. Menorrhagia. N Z Med J 1993 Jun 23; 106(958): 255–7

    PubMed  CAS  Google Scholar 

  136. Lukes AS, Moore KA, Muse KN, et al. Tranexamic acid treatment for heavy menstrual bleeding: a randomized controlled trial. Obstet Gynecol 2010 Oct; 116(4): 865–75

    PubMed  Google Scholar 

  137. Bonnar J, Sheppard BL. Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid. BMJ 1996 Sep 7; 313(7057): 579–82

    PubMed Central  PubMed  CAS  Google Scholar 

  138. Preston JT, Cameron IT, Adams EJ, et al. Comparative study of tranexamic acid and norethisterone in the treatment of ovulatory menorrhagia. Br J Obstet Gynaecol 1995 May; 102(5): 401–6

    PubMed  CAS  Google Scholar 

  139. Milsom I, Andersson K, Andersch B, et al. A comparison of flurbiprofen, tranexamic acid, and a levonorgestrel-releasing intrauterine contraceptive device in the treatment of idiopathic menorrhagia. Am J Obstet Gynecol 1991 Mar; 164(3): 879–83

    PubMed  CAS  Google Scholar 

  140. Kouides PA, Byams VR, Philipp CS, et al. Multisite management study of menorrhagia with abnormal laboratory haemostasis: a prospective crossover study of intranasal desmopressin and oral tranexamic acid. Br J Haematol 2009; 145(2): 212–20

    PubMed  CAS  Google Scholar 

  141. Callender ST, Warner GT, Cope E. Treatment of menorrhagia with tranexamic acid: a double-blind trial. Br Med J 1970 Oct 24; 4(729): 214–6

    PubMed Central  PubMed  CAS  Google Scholar 

  142. Ducloy-Bouthors A-S, Jude B, Duhamel A, et al. Highdose tranexamic acid reduces blood loss in postpartum haemorrhage. Crit Care 2011; 15(2): R117

    PubMed Central  PubMed  Google Scholar 

  143. Gungorduk K, Yildirim G, Asicioglu O, et al. Efficacy of intravenous tranexamic acid in reducing blood loss after elective cesarean section: a prospective, randomized, double-blind, placebo-controlled study. Am J Perinatol 2011; 28(3): 233–9

    PubMed  Google Scholar 

  144. Sekhavat L, Tabatabaii A, Dalili M, et al. Efficacy of tranexamic acid in reducing blood loss after cesarean section. J Matern-Fetal Neonatal Med 2009 Jan; 22(1): 72–5

    PubMed  CAS  Google Scholar 

  145. Gai M-Y, Wu L-F, Su Q-F, et al. Clinical observation of blood loss reduced by tranexamic acid during and after caesarian section: a multi-center, randomized trial. Eur J Obstet Gynecol Reprod Biol 2004; 112(2): 154–7

    PubMed  CAS  Google Scholar 

  146. Movafegh A, Eslamian L, Dorabadi A. Effect of intravenous tranexamic acid administration on blood loss during and after cesarean delivery. Int J Gynaecol Obstet 2011 Dec; 115(3): 224–6

    PubMed  CAS  Google Scholar 

  147. Gohel M, Patel P, Gupta A, et al. Efficacy of tranexamic acid in decreasing blood loss during and after cesarean section: a randomized case controlled prospective study. J Obstet Gynecol India 2007; 57(3): 227–30

    Google Scholar 

  148. Shakur H, Elbourne D, Gülmezoglu M, et al. The WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double blind placebo controlled trial. Trials 2010; 11: 40

    PubMed Central  PubMed  Google Scholar 

  149. Senthong A-J, Taneepanichskul S. The effect of tranexamic acid for treatment irregular uterine bleeding secondary to DMPA use. J Med Assoc Thailand 2009; 92(4): 461–5

    Google Scholar 

  150. Phupong V, Sophonsritsuk A, Taneepanichskul S. The effect of tranexamic acid for treatment of irregular uterine bleeding secondary to Norplant® use. Contraception 2006; 73(3): 253–6

    PubMed  CAS  Google Scholar 

  151. Barer D, Ogilvie A, Henry D, et al. Cimetidine and tranexamic acid in the treatment of acute upper-gastrointestinaltract bleeding. N Engl J Med 1983 Jun 30; 308(26): 1571–5

    PubMed  CAS  Google Scholar 

  152. Bergqvist D, Dahlgren S, Hessman Y. Local inhibition of the fibrinolytic system in patients with massive upper gastrointestinal hemorrhage. Ups J Med Sci 1980; 85(2): 173–8

    PubMed  CAS  Google Scholar 

  153. Biggs JC, Hugh TB, Dodds AJ. Tranexamic acid and upper gastrointestinal haemorrhage: a double-blind trial. Gut 1976 Sep; 17(9): 729–34

    PubMed Central  PubMed  CAS  Google Scholar 

  154. Cormack F, Chakrabarti RR, Jouhar AJ, et al. Tranexamic acid in upper gastrointestinal haemorrhage. Lancet 1973 Jun 2; 1(7814): 1207–8

    PubMed  CAS  Google Scholar 

  155. Engqvist A, Broström O, von Feilitzen F, et al. Tranexamic acid in massive haemorrhage from the upper gastrointestinal tract: a double-blind study. Scand J Gastroenterol 1979; 14(7): 839–44

    PubMed  CAS  Google Scholar 

  156. Staël von Holstein CCS, Eriksson SBS, Källén R. Tranexamic acid as an aid to reducing blood transfusion requirements in gastric and duodenal bleeding. Br Med J (Clin Res Ed) 1987 Jan 3; 294(6563): 7–10

    Google Scholar 

  157. Vermeulen M, Lindsay KW, Murray GD, et al. Anti-fibrinolytic treatment in subarachnoid hemorrhage. N Engl J Med 1984 Aug 16; 311(7): 432–7

    PubMed  CAS  Google Scholar 

  158. Roos Y. Antifibrinolytic treatment in subarachnoid hemorrhage: a randomized placebo-controlled trial. STAR Study Group. Neurology 2000 Jan 11; 54(1): 77–82

    CAS  Google Scholar 

  159. Hillman J, Fridriksson S, Nilsson O, et al. Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage: a prospective randomized study. J Neurosurg 2002; 97(4): 771–8

    PubMed  CAS  Google Scholar 

  160. Sauaia A, Moore FA, Moore EE, et al. Epidemiology of trauma deaths: a reassessment. J Trauma 1995 Feb; 38(2): 185–93

    PubMed  CAS  Google Scholar 

  161. CRASH-2 Trial Collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010; 376(9734): 23–32

    Google Scholar 

  162. CRASH-2 Collaborators (Intracranial Bleeding Study). Effect of tranexamic acid in traumatic brain injury: a nested randomised, placebo controlled trial (CRASH-2 Intracranial Bleeding Study). BMJ 2011; 343 (7816)

  163. CRASH-2 Collaborators. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet 2011; 377(9771): 1096–101.e2

    Google Scholar 

  164. CRASH-2 Collaborators. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet 2011; 377(9771): 1096–101.e2

    Google Scholar 

  165. Varnek L, Dalsgaard C, Hansen A, et al. The effect of tranexamic acid on secondary haemorrhage after traumatic hyphaema. Acta Ophthalmol (Copenh) 1980 Oct; 58(5): 787–93

    CAS  Google Scholar 

  166. Jerndal T, Frisen M. Tranexamic acid (AMCA) and late hyphaema: a double blind study in cataract surgery. Acta Ophthalmol (Copenh) 1976 Aug; 54(4): 417–29

    CAS  Google Scholar 

  167. Morabe ES, Alivia JR, Samonte EP. Comparative study of conservative and tranexamic acid treatment in traumatic hyphema. J Philipp Med Assoc 1992 Jul–Sep; 68: 20–3

    Google Scholar 

  168. Rahmani B, Jahadi HR. Comparison of tranexamic acid and prednisolone in the treatment of traumatic hyphema: a randomized clinical trial. Ophthalmology 1999; 106(2): 375–9

    PubMed  CAS  Google Scholar 

  169. Blohmé G. Treatment of hereditary angioneurotic oedema with tranexamic acid: a random double-blind cross-over study. Acta Med Scand 1972 Oct; 192(4): 293–8

    PubMed  Google Scholar 

  170. Sheffer AL, Austen KF, Rosen FS. Tranexamic acid therapy in hereditary angioneurotic edema. N Engl J Med 1972 Aug 31; 287(9): 452–4

    PubMed  CAS  Google Scholar 

  171. Guerriero C, Cairns J, Jayaraman S, et al. Giving tranexamic acid to reduce surgical bleeding in sub-Saharan Africa: an economic evaluation. Cost Eff Resour Allocat 2010 Feb 17; 8: 1

    Google Scholar 

  172. Guerriero C, Cairns J, Perel P, et al. Cost-effectiveness analysis of administering tranexamic acid to bleeding trauma patients using evidence from the CRASH-2 trial. PLoS ONE 2011; 6(5): e18987

    PubMed Central  PubMed  CAS  Google Scholar 

  173. Muse K, Lukes AS, Gersten J, et al. Long-term evaluation of safety and health-related quality of life in women with heavy menstrual bleeding treated with oral tranexamic acid. Womens Health (Lond Engl) 2011 Nov; 7(6): 699–707

    PubMed  CAS  Google Scholar 

  174. Lukes AS, Freeman EW, Van Drie D, et al. Safety of tranexamic acid in women with heavy menstrual bleeding: an open-label extension study. Women’s Health 2011; 7(5): 591–8

    PubMed  CAS  Google Scholar 

  175. Takagi H, Manabe H, Kawai N, et al. Aprotinin increases mortality as compared with tranexamic acid in cardiac surgery: a meta-analysis of randomized head-to-head trials. Interact Cardiovasc Thorac Surg 2009; 9(1): 98–101

    PubMed  Google Scholar 

  176. Karski J, Djaiani G, Carroll J, et al. Tranexamic acid and early saphenous vein graft patency in conventional coronary artery bypass graft surgery: a prospective randomized controlled clinical trial. J Thorac Cardiovasc Surg 2005; 130(2): 309–14

    PubMed  CAS  Google Scholar 

  177. Martin K, Knorr J, Breuer T, et al. Seizures after open heart surgery: comparison of e-aminocaproic acid and tranexamic acid. J Cardiothorac Vasc Anesth 2011; 25(1): 20–5

    PubMed  CAS  Google Scholar 

  178. Keyl C, Uhl R, Beyersdorf F, et al. High-dose tranexamic acid is related to increased risk of generalized seizures after aortic valve replacement. Eur J Cardio-Thorac Surg 2011; 39(5): e114–121

    Google Scholar 

  179. Murkin JM, Falter F, Granton J, et al. High-dose tranexamic acid is associated with nonischemic clinical seizures in cardiac surgical patients. Anesth Analg 2010; 110(2): 350–3

    PubMed  CAS  Google Scholar 

  180. Sander M, Spies CD, Martiny V, et al. Mortality associated with administration of high-dose tranexamic acid and aprotinin in primary open-heart procedures: a retrospective analysis. Crit Care 2010; 14(4): R148

    PubMed Central  PubMed  Google Scholar 

  181. Kalavrouziotis D, Voisine P, Mohammadi S, et al. Highdose tranexamic acid is an independent predictor of early seizure after cardiopulmonary bypass. Ann Thorac Surg 2012 Jan; 93(1): 148–54

    PubMed  Google Scholar 

  182. Casati V, Romano A, Novelli E, et al. Tranexamic acid for trauma [letter]. Lancet 2010; 376(9746): 1049–50; author reply 1050–1051

    PubMed  Google Scholar 

  183. Martin K, Wiesner G, Breuer T, et al. The risks of aprotinin and tranexamic acid in cardiac surgery: a one-year follow-up of 1188 consecutive patients. Anesth Analg 2008; 107(6): 1783–90

    PubMed  CAS  Google Scholar 

  184. Imbesi S, Nettis E, Minciullo PL, et al. Hypersensitivity to tranexamic acid: a wide spectrum of adverse reactions. Pharm World Sci 2010; 32(4): 416–9

    PubMed  CAS  Google Scholar 

  185. Health Canada. Health Canada decision on Trasylol (aprotinin) [media release]. 2011 Sep 21 [online]. Available from URL: http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2011/2011_124-eng.php [Accessed 2012 Feb 23]

  186. European Medicines Agency. Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 15–18 March 2010 [media release]. 2010 Mar 19 [online]. Available from URL: http://www.ema.europa.eu/docs/en_GB/document_library/Press_release/2010/03/WC500076041.pdf [Accessed 2012 Feb 23]

  187. Wellington K, Wagstaff AJ. Tranexamic acid: a review of its use in the management of menorrhagia. Drugs 2003; 63(13): 1417–33

    PubMed  CAS  Google Scholar 

  188. Culligan WB, Tien HC. Tranexamic acid autoinjector for prehospital care of noncompressible hemorrhage. J Trauma 2011 Nov; 71 (5 Suppl. 1): S501–502

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Paul L. McCormack.

Additional information

Various sections of the manuscript reviewed by: V. Casati, Clinica San Gaudenzio (Policlinico di Monza Group), Division of Cardiovascular Anaesthesia and Intensive Care, Novara, Italy; W. Dietrich, Institute for Research in Cardiac Anesthesia, Munich, Germany; A.-S. Ducloy-Bouthors, Pole d’Anesthésie-Réanimation, CHU Lille, Lille, France; S.M. Elwatidy, Division of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia; M.R. Farrokhi, Shiraz Neurosciences Research Center, Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran; K. Hekmat, Department of Thoracic and Cardiovascular Surgery, University of Cologne, Cologne, Germany; J. Wong, Department of Anesthesia, University Health Network, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada; P.J. Zufferey, Department of Anaesthesiology and Intensive Care, University Hospital of Saint-Étienne, Saint-Étienne, France.

Data Selection

Sources: Medical literature (including published and unpublished data) on ‘tranexamic acid’ was identified by searching databases (including MEDLINE and EMBASE) for articles published since 1996, bibliographies from published literature, clinical trial registries/databases and websites (including those of regional regulatory agencies and the manufacturer). Additional information (including contributory unpublished data) was also requested from the company developing the drug.

Search strategy: MEDLINE and EMBASE search terms were ‘tranexamic acid’ and (‘blood loss’ or ‘bleeding’ or ‘menorrhagia’ or ‘epistaxis’ or ‘surgery’ or ‘angioneurotic edema’ or ‘angioneurotic oedema’ or ‘angioedema’ or ‘cancer’ or ‘neoplasm’ or ‘neoplasms’ or ‘leukemia’ or ‘leukaemia’ or ‘surgical blood loss’ or ‘blood transfusion’). Searches were last updated 23 February 2012.

Selection: Studies in patients who received tranexamic acid for the treatment of conditions involving hyperfibrinolysis. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well controlled trials with appropriate statistical methodology were preferred. Relevant pharmacodynamic and pharmacokinetic data are also included.

Index terms: Tranexamic acid, blood loss prevention, haemostasis, pharmacodynamics, pharmacokinetics, pharmacoeconomics, therapeutic use, tolerability.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McCormack, P.L. Tranexamic Acid. Drugs 72, 585–617 (2012). https://doi.org/10.2165/11209070-000000000-00000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11209070-000000000-00000

Keywords

Navigation