Tranexamic acid for haemostasis and beyond: does dose matter?

Thrombosis Journal

Review

Robert L. Medcalf¹  Charithani B. Keragala¹  Tammy Lam¹  Paul S. Myles²  Geoffrey C. Cloud³ 

[1] Australian Centre for Blood Diseases, Monash AMREP Building, Monash University, Level 1 Walkway, Via The Alfred Centre, 99 Commercial Rd, 3004, Melbourne, Australia;Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne VIC, Australia;Department of Anaesthesiology and Perioperative Medicine, Monash University, Melbourne VIC, Australia;Department of Clinical Neuroscience, Central Clinical School, Monash University, Melbourne, Australia;

关键词: Tranexamic acid;    Fibrinolysis;    Thrombosis;    Immunity;    Amyloid;    Pharmacology;    Surgery;   

DOI  :  10.1186/s12959-023-00540-0

 received in 2023-07-24, accepted in 2023-09-04,  发布年份 2023

来源: Springer

【 摘 要 】

Tranexamic acid (TXA) is a widely used antifibrinolytic agent that has been used since the 1960’s to reduce blood loss in various conditions. TXA is a lysine analogue that competes for the lysine binding sites in plasminogen and tissue-type plasminogen activator impairing its interaction with the exposed lysine residues on the fibrin surface. The presence of TXA therefore, impairs the plasminogen and tPA engagement and subsequent plasmin generation on the fibrin surface, protecting fibrin clot from proteolytic degradation. However, critical lysine binding sites for plasmin(ogen) also exist on other proteins and on various cell-surface receptors allowing plasmin to exert potent effects on other targets that are unrelated to classical fibrinolysis, notably in relation to immunity and inflammation. Indeed, TXA was reported to significantly reduce post-surgical infection rates in patients after cardiac surgery unrelated to its haemostatic effects. This has provided an impetus to consider TXA in other indications beyond inhibition of fibrinolysis. While there is extensive literature on the optimal dosage of TXA to reduce bleeding rates and transfusion needs, it remains to be determined if these dosages also apply to blocking the non-canonical effects of plasmin.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

13690_2023_1170_Article_IEq85.gif

Fig. 3