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Blood Reviews Mar 1989Antifibrinolytic drugs, in particular, epsilon-aminocaproic acid and tranexamic acid, have been used in the management of a wide range of both bleeding and... (Review)
Review
Antifibrinolytic drugs, in particular, epsilon-aminocaproic acid and tranexamic acid, have been used in the management of a wide range of both bleeding and non-haemorrhagic disorders. Recognition of their side-effects and complications, comparison of their efficacy with other forms of therapy and more critical evaluation of their value has reduced the range of their definitive indications to a limited number of relatively uncommon situations; these comprise primary hyperplasminaemia, menorrhagia in women in whom oestrogens are contraindicated or in those with von Willebrand's disease, severe traumatic hyphaema, dental extraction in haemophiliacs and hereditary angioedema in patients in whom treatment with anabolic steroids is contraindicated. In a few conditions the possible benefit of antifibrinolytic agents, alone or supplementary to other forms of therapy, is unresolved; these include upper gastrointestinal bleeding, recurrent epistaxis and abruptio placentae.
Topics: Antifibrinolytic Agents; Humans
PubMed: 2650771
DOI: 10.1016/0268-960x(89)90019-2 -
Frontiers of Neurology and Neuroscience 2016Symptomatic cerebral atherosclerosis including intracranial atherosclerosis (ICAS) is associated with a high risk of recurrent stroke. Antithrombotic agents are the... (Review)
Review
Symptomatic cerebral atherosclerosis including intracranial atherosclerosis (ICAS) is associated with a high risk of recurrent stroke. Antithrombotic agents are the mainstay of therapy in these patients. Several studies have found anticoagulation (warfarin) to increase the risk of bleeding events and have an efficacy no better than that of aspirin. Therefore, anticoagulants are not widely used unless patients develop recurrent ischemic symptoms despite receiving antiplatelet therapy. Because ICAS progression is not uncommon and the risk of stroke recurrence is high when aspirin monotherapy is used, dual antiplatelet agents may be needed at least in the early disease stage. The Trial of Cilostazol in Symptomatic Intracranial Stenosis (TOSS) found that aspirin plus cilostazol was significantly better than aspirin monotherapy in preventing progression (6.7 vs. 28.8%, p = 0.008). The TOSS II trial that compared aspirin plus cilostazol with aspirin plus clopidogrel found no significant difference in the progression rate (9.3% vs. 15.5%, p = 0.092). However, the overall changes in stenosis were more favorable (i.e., less progression and more regression) in the cilostazol group (p = 0.049). TOSS studies have limitations in that the end points were changes in magnetic resonance angiography results rather than clinical outcomes. Based on the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial results, and the fair outcome found in patients enrolled in the SAMMPRIS (Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis) trial, aspirin plus clopidogrel has been recommended in the early stage of symptomatic ICAS. However, the combination of aspirin and clopidogrel did not show superiority over aspirin monotherapy in ICAS patients in a recent CHANCE substudy. Considering that ICAS is the major pathology leading to stroke worldwide, further studies are needed to identify the best medication strategy in ICAS patients. Until then, physicians may choose appropriate antiplatelet agents after careful consideration of the characteristics of both the patients (i.e., degree of stenosis, stroke mechanism, risk of stroke, and risk of bleeding) and the antiplatelet agent (e.g., side effect, cost).
Topics: Antifibrinolytic Agents; Fibrinolytic Agents; Humans; Intracranial Arteriosclerosis
PubMed: 27960183
DOI: 10.1159/000448310 -
Journal of Cosmetic Dermatology Apr 2023Tranexamic acid, a synthetic derivative of the amino acid lysine, is an antifibrinolytic, procoagulant agent approved by the Food and Drug Administration for the... (Review)
Review
BACKGROUND
Tranexamic acid, a synthetic derivative of the amino acid lysine, is an antifibrinolytic, procoagulant agent approved by the Food and Drug Administration for the treatment of cyclic heavy menstrual bleeding and prevention of bleeding in patients with hemophilia undergoing tooth extraction. Oral tranexamic acid has been used off-label in dermatology in the treatment of melasma and other hyperpigmentation disorders. In a recent study, oral tranexamic acid was reviewed thoroughly in treating melasma, and its effectiveness was demonstrated. Their role in treating other hyperpigmentation disorders has also been tried in several studies.
AIM
To review the evidence regarding the use of tranexamic acid in treating different types of hyperpigmentation disorders other than melasma.
METHODOLOGY
A comprehensive literature review was searched using the electronic online database "PubMed" and "google scholar" using key words "Postinflammatory hyperpigmentation," "lichen planus pigmentosus," "ashy dermatosis," "riehl melanosis". After that, a full-text review of the studies was performed.
RESULT
Oral tranexamic acid has been used in different types of hyperpigmentation disorder, including postinflammatory hyperpigmentation treatment and prevention, lichen planus pigmentosus, ashy dermatosis, and Riehl melanosis in a dose range from 250 mg per day to 1500 mg per day for a period range from 2 weeks to 6 months with variable efficacy and a good safety profile.
CONCLUSION
Oral tranexamic acid is a promising treatment option in a different type of hyperpigmentation disorders refractory to topical treatment. However, more evidence from blinded randomized controlled trials and case-control studies is needed to determine their efficacy in treating various hyperpigmentation disorders.
Topics: Humans; Tranexamic Acid; Melanosis; Hyperpigmentation; Antifibrinolytic Agents; Lichen Planus; Treatment Outcome
PubMed: 36575866
DOI: 10.1111/jocd.15561 -
Clinical and Experimental Dermatology Jun 2020Tranexamic acid (TA) is an antifibrinolytic agent, increasingly recognized as being of utility for a wide variety of skin diseases. We review the evidence supporting the... (Review)
Review
Tranexamic acid (TA) is an antifibrinolytic agent, increasingly recognized as being of utility for a wide variety of skin diseases. We review the evidence supporting the use of TA for a range of dermatological indications, including (among others) melasma, postinflammatory hyperpigmentation, urticaria, angio-oedema and haemostasis, in addition to practical considerations of its use by dermatologists.
Topics: Angioedema; Antifibrinolytic Agents; Dermatology; Hemorrhage; Humans; Melanosis; Pigmentation Disorders; Skin Diseases; Tranexamic Acid; Urticaria
PubMed: 31663643
DOI: 10.1111/ced.14115 -
Lancet (London, England) Nov 2011
Topics: Adult; Antifibrinolytic Agents; Cost-Benefit Analysis; Hemorrhage; Humans; Information Dissemination; Internet; Randomized Controlled Trials as Topic; Tranexamic Acid; Wounds and Injuries
PubMed: 22098842
DOI: 10.1016/S0140-6736(11)61760-1 -
The Laryngoscope Oct 2013Symptomatic bleeding among patients with advanced upper aerodigestive tract tumor is a challenging problem. Given the limited options for topical treatment, embolization... (Review)
Review
OBJECTIVES/HYPOTHESIS
Symptomatic bleeding among patients with advanced upper aerodigestive tract tumor is a challenging problem. Given the limited options for topical treatment, embolization is often required to control the hemorrhage. There are recent reported cases of novel and successful treatment of patients with recalcitrant tracheo-bronchial bleed with tranexamic acid. We therefore described our initial experience of four consecutive cases of patients with bleeding from advanced aerodigestive tract tumor, successfully treated with oral tranexamic acid.
STUDY DESIGN
Case series.
METHODS
Case series of four consecutive patients with acute bleed from upper aerodigestive tract tumors, treated with oral tranexamic acid. Tranexamic acid was administered topically and systemically (1gm PO QID) for the orophayngeal and supraglottic tumor cases, where as systemic-only therapy were administered to the patients with nasal and nasopharyngeal tumors.
RESULTS
None of the patients experienced further bleeding following the commencement of tranexamic acid treatment, and no adverse effect was noted. These are the first reported cases of symptomatic upper aerodigestive hemorrhage being controlled with tranexamic acid. It is increasingly being used in patients with life-threatening bleeding following trauma and major surgery. The optimum dose of tranexamic acid is undetermined. In vivo studies suggested concentrations of 10 μg/mL to 16 μg/mL for optimal anti-fibrinolytic effect, which is achievable with 1gm QID of oral administration. Large randomized controlled trials assessing the utility of tranexamic acid in various orthopedic surgeries did not show increased thromboembolic events.
CONCLUSIONS
Tranexamic acid should be considered for patients with symptomatic nonarterial bleeding of the upper aerodigestive tract tumors.
LEVEL OF EVIDENCE
4.
Topics: Administration, Oral; Aged; Aged, 80 and over; Antifibrinolytic Agents; Carcinoma, Squamous Cell; Epistaxis; Glottis; Head and Neck Neoplasms; Hemorrhage; Humans; Laryngeal Neoplasms; Magnetic Resonance Imaging; Male; Nasopharyngeal Neoplasms; Pharyngeal Neoplasms; Squamous Cell Carcinoma of Head and Neck; Tomography, X-Ray Computed; Tranexamic Acid
PubMed: 23553514
DOI: 10.1002/lary.24064 -
The Cochrane Database of Systematic... Jul 2018Individuals on continuous treatment with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) are at increased risk of bleeding complications during and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Individuals on continuous treatment with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) are at increased risk of bleeding complications during and after oral or dental procedures. Anticoagulant treatment is preferably continued at the same dose, since dose reduction or discontinuation of treatment is associated with an increased risk of thromboembolism. The use of haemostatic measures during or after the procedure (or both) could enable continuation of the oral anticoagulant treatment.
OBJECTIVES
We aimed to assess the efficacy of antifibrinolytic agents for preventing bleeding complications in people on oral anticoagulants undergoing minor oral surgery or dental extractions.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews. We searched PubMed, Embase and the Cochrane Library. Additional searches were performed using ClinicalTrials.gov, the International Clinical Trials Registry Platform (ICTRP), the CINAHL database of nursing and allied health services, the open access ProQuest dissertation database, papers and reports from the American College of Clinical Pharmacy (ACCP) and abstract books from annual scientific conferences.Date of last search: 04 January 2018.
SELECTION CRITERIA
Randomised and quasi-randomised controlled trials in people on continuous treatment with VKAs or DOACs undergoing oral or dental procedures using antifibrinolytic agents (tranexamic acid (TXA) or epsilon aminocaproic acid) to prevent perioperative bleeding compared to no intervention or usual care with or without placebo.
DATA COLLECTION AND ANALYSIS
Two authors independently screened the titles and abstracts of all identified articles. Full texts were obtained from potentially relevant abstracts and two authors independently assessed these for inclusion based of the selection criteria. A third author verified trial eligibility. Two authors independently performed data extraction and risk of bias assessments using standardized forms. The quality of the evidence was assessed using GRADE.
MAIN RESULTS
No eligible trials in people on continuous treatment with DOACs undergoing oral or dental procedures were identified.Three randomised trials and one quasi-randomised trial (follow-up in all was seven days) in people on continuous treatment with VKAs were included with a total of 253 participants (mean age 60 years). Two trials published in 1989 and 1993 compared the antifibrinolytic agent TXA with placebo in people using VKAs. Two other trials were published in 1999 and 2015 and compared TXA with gelatin sponge and sutures, and dry gauze compression, respectively. In all included trials, those who were treated with VKAs had international normalised ratio (INR) values within the therapeutic range and TXA was applied locally, not systemically.The two trials from 1989 and 1993 comparing TXA with placebo showed a statistically significant beneficial effect regarding the number of major postoperative bleeding episodes requiring intervention, with a pooled risk difference (RD) of -0.25 (95% confidence interval (CI) -0.36 to -0.14) (128 participants) (moderate-quality evidence). For the two trials that compared TXA with either gelatin sponge and sutures or with dry gauze compression, there was no difference between the TXA and the standard care group, RD 0.02 (95% CI -0.07 to 0.11) (125 participants) (moderate-quality evidence). The combined RD of all included trials was -0.13 (95% CI -0.30 to 0.05) (moderate-quality evidence). There were no side effects of antifibrinolytic therapy that required treatment withdrawal (128 participants) (moderate-quality evidence). Despite heterogeneity between trials with respect to the different haemostatic measures used in the control groups, the trials were comparable regarding design and baseline participant characteristics.Overall, we considered the risk of bias to be low in the trials comparing TXA with placebo and moderate in the trials comparing TXA with alternative haemostatic measures.
AUTHORS' CONCLUSIONS
Based on the results of this Cochrane Review, there seems to be a beneficial effect of locally applied TXA in preventing oral bleeding in people on continuous treatment with VKAs undergoing minor oral surgery or dental extractions. However, the small number of identified randomised controlled trials, the relatively small number of participants included in the trials and the differences in standard therapy and treatment regimens between trials, do not allow us to conclude definite efficacy of antifibrinolytic therapy in this population.We were unable to identify any eligible trials in people on continuous treatment with DOACs undergoing oral or dental procedures. Therefore, a beneficial effect of antifibrinolytic therapy can currently only be assumed based on data from the people using VKAs.
Topics: Anticoagulants; Antifibrinolytic Agents; Humans; Middle Aged; Minor Surgical Procedures; Oral Hemorrhage; Oral Surgical Procedures; Tooth Extraction; Tranexamic Acid
PubMed: 29963686
DOI: 10.1002/14651858.CD012293.pub2 -
Current Opinion in Anaesthesiology Jun 2019Perioperative bleeding and blood product transfusion are associated with significant morbidity and mortality. Prevention and optimal management of bleeding decreases... (Review)
Review
PURPOSE OF REVIEW
Perioperative bleeding and blood product transfusion are associated with significant morbidity and mortality. Prevention and optimal management of bleeding decreases risk and lowers costs. Tranexamic acid (TXA) is an antifibrinolytic agent that reduces bleeding and transfusion in a broad number of adult and pediatric surgeries, as well as in trauma and obstetrics. This review highlights the current pediatric indications and contraindications of TXA. The efficacy and safety profile, given current and evolving research, will be covered.
RECENT FINDINGS
Based on the published evidence, prophylactic or therapeutic TXA administration is a well-tolerated and effective strategy to reduce bleeding, decrease allogeneic blood product transfusion, and improve pediatric patients' outcomes. TXA is now recommended in recent guidelines as an important part of pediatric blood management protocols.
SUMMARY
Based on TXA pharmacokinetics, the authors recommend a dosing regimen of between 10 to 30 mg/kg loading dose followed by 5 to 10 mg/kg/h maintenance infusion rate for pediatric trauma and surgery. Maximal efficacy and minimal side-effects with this dosage regime will have to be determined in larger prospective trials including high-risk groups. Furthermore, future research should focus on determining the ideal TXA plasma therapeutic concentration for maximum efficacy and minimal side-effects.
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Blood Transfusion; Child; Dose-Response Relationship, Drug; Humans; Infusions, Intravenous; Perioperative Care; Postoperative Hemorrhage; Practice Guidelines as Topic; Surgical Procedures, Operative; Tranexamic Acid; Transfusion Reaction; Treatment Outcome
PubMed: 30893114
DOI: 10.1097/ACO.0000000000000728 -
The Journal of Bone and Joint Surgery.... Nov 2008Antifibrinolytic agents have been shown to decrease the blood loss associated with major orthopaedic surgical procedures. Spine surgery, particularly procedures... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Antifibrinolytic agents have been shown to decrease the blood loss associated with major orthopaedic surgical procedures. Spine surgery, particularly procedures performed for deformity correction and procedures involving long arthrodesis constructs, can be associated with a large amount of blood loss requiring blood transfusions. The purpose of the present study was to determine if antifibrinolytic agents reduced blood transfusions in patients managed with spine surgery and to see if one agent had a greater effect than another.
METHODS
A systematic review and meta-analysis of the available literature were performed to investigate the efficacy of aprotinin, tranexamic acid, and epsilon-aminocaproic acid in terms of reducing blood loss and blood transfusions in patients undergoing spine surgery. This meta-analysis was focused on the role of these agents in major spine operations as reported in eighteen clinical trials that included information on the drug dosage, the age of the patient, blood loss, blood transfusions, surgery complexity, and complications.
RESULTS
Compared with control groups, the treatment groups for all three antifibrinolytic agents maintained lower levels of total blood loss and transfusions associated with spine surgery. The effect size (d) of the differences in total blood loss between the treatment and control groups ranged from -0.668 (95% confidence interval, -0.971 to -0.365) to -0.936 (95% confidence interval, -1.240 to -0.632) across all three agents. The effect size (d) of the differences in total blood transfusions between the treatment and control groups ranged from -0.466 (95% confidence interval, -0.764 to -0.167) to -0.749 (95% confidence interval, -1.046 to -0.453) across all three agents.
CONCLUSIONS
Aprotinin, tranexamic acid, and epsilon-aminocaproic acid are effective for reducing blood loss and transfusions in patients managed with spine surgery. With the exception of aprotinin, the side-effect profiles of these agents have not been shown to cause any substantial morbidity or to increase the rate of thromboembolic events. Epsilon-aminocaproic acid had a greater effect on reducing blood transfusions as the complexity of surgery increased. The surgeon and/or the anesthesiologist should consider the use of antifibrinolytic agents for patients undergoing spinal procedures in which a large amount of blood loss can be expected; however, at the present time, this is not a United States Food and Drug Administration-approved indication for these agents.
Topics: Adolescent; Adult; Aminocaproic Acid; Antifibrinolytic Agents; Aprotinin; Blood Loss, Surgical; Humans; Middle Aged; Spine; Tranexamic Acid
PubMed: 18978408
DOI: 10.2106/JBJS.G.01179 -
Expert Review of Hematology Sep 2019: Postpartum hemorrhage (PPH) is a major cause of maternal death and severe maternal morbidity after childbirth. : Tranexamic acid, an antifibrinolytic agent, reduces... (Review)
Review
: Postpartum hemorrhage (PPH) is a major cause of maternal death and severe maternal morbidity after childbirth. : Tranexamic acid, an antifibrinolytic agent, reduces bleeding-related mortality in women with PPH, especially when administered shortly after delivery, and is consequently recommended in this situation (1g intravenously with a second dose of 1 g if bleeding continues), even in high income countries where the magnitude of the effect of tranexamic is uncertain. : Pharmacovigilance surveys are warranted in high income areas to ensure that this new policy for the treatment of PPH is not associated to rare but severe adverse events such as renal failure. The evidence remains insufficient to recommend the universal use of tranexamic acid for prevention of postpartum hemorrhage after both vaginal and cesarean deliveries.
Topics: Antifibrinolytic Agents; Female; Humans; Parturition; Postpartum Hemorrhage; Pregnancy; Tranexamic Acid; Treatment Outcome
PubMed: 31295414
DOI: 10.1080/17474086.2019.1642744