Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.08.022
Brazilian Journal of Anesthesiology
Narrative Review

Clinical use of tranexamic acid: evidences and controversies

Uso clínico do ácido tranexâmico: evidências e controvérsias

Maria J. Colomina, Laura Contreras, Patricia Guilabert, Maylin Koo, Esther Méndez, Antoni Sabate

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Abstract

Tranexamic acid (TXA) significantly reduces blood loss in a wide range of surgical procedures and improves survival rates in obstetric and trauma patients with severe bleeding. Although it mainly acts as a fibrinolysis inhibitor, it also has an anti-inflammatory effect, and may help attenuate the systemic inflammatory response syndrome found in some cardiac surgery patients. However, the administration of high doses of TXA has been associated with seizures and other adverse effects that increase the cost of care, and the administration of TXA to reduce perioperative bleeding needs to be standardized.

Tranexamic acid is generally well tolerated, and most adverse reactions are considered mild or moderate. Severe events are rare in clinical trials, and literature reviews have shown tranexamic acid to be safe in several different surgical procedures. However, after many years of experience with TXA in various fields, such as orthopedic surgery, clinicians are now querying whether the dosage, route and interval of administration currently used and the methods used to control and analyze the antifibrinolytic mechanism of TXA are really optimal. These issues need to be evaluated and reviewed using the latest evidence to improve the safety and effectiveness of TXA in treating intracranial hemorrhage and bleeding in procedures such as liver transplantation, and cardiac, trauma and obstetric surgery.

Keywords

Tranexamic acid;  Antifibrinolytics;  Liver surgery;  Cardiac surgery;  Subarachnoid hemorrhage;  Trauma;  Orthopedic surgery;  Obstetric hemorrhage

Resumo

O ácido tranexâmico (ATX) reduz significativamente a perda de sangue em uma ampla gama de procedimentos cirúrgicos e melhora as taxas de sobrevida em pacientes obstétricas e de trauma com sangramento grave. Embora atue principalmente como inibidor da fibrinólise, também tem efeito anti-inflamatório, podendo ajudar a atenuar a síndrome da resposta inflamatória sistêmica encontrada em alguns pacientes de cirurgia cardíaca. No entanto, a administração de altas doses de ATX tem sido associada a convulsões e outros efeitos adversos que aumentam o custo do atendimento, e a administração de ATX para reduzir o sangramento perioperatório precisa ser padronizada. O ácido tranexâmico é geralmente bem tolerado e a maioria das reações adversas são consideradas leves ou moderadas. Eventos graves são raros em ensaios clínicos, e revisões de literatura têm demonstrado que o ácido tranexâmico é seguro em diversos procedimentos cirúrgicos. No entanto, após muitos anos de experiência com ATX em vários campos, como cirurgia ortopédica, os médicos agora estão questionando se a dosagem, via e intervalo de administração atualmente usados e os métodos usados para controlar e analisar o mecanismo antifibrinolítico do ATX são realmente ideais. Essas questões precisam ser avaliadas e revisadas usando as evidências mais recentes para melhorar a segurança e a eficácia do ATX no tratamento de hemorragia e sangramento intracraniano em procedimentos como transplante de fígado, cirurgia cardíaca, trauma e obstétrica.

Palavras-chave

Ácido tranexâmico; Antifibrinolíticos; Cirurgia do fígado; Cirurgia cardíaca; Hemorragia subaracnoide; Trauma; Cirurgia ortopédica; Hemorragia obstétrica

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