Efficacy and safety of tranexamic acid in acute haemorrhage
BMJ 2024; 384 doi: https://doi.org/10.1136/bmj-2023-075720 (Published 04 January 2024) Cite this as: BMJ 2024;384:e075720
- Massimo Franchini, haematologist1,
- Daniele Focosi, haematologist2,
- Marco Zaffanello, paediatrician3,
- Pier Mannuccio Mannucci, professor of medicine4
- 1Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
- 2North-Western Tuscany Blood Bank, Pisa University Hospital, Italy
- 3Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
- 4Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico and University of Milan, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
- Correspondence to M Franchini massimo.franchini{at}asst-mantova.it
What you need to know
Tranexamic acid is a synthetic haemostatic drug that inhibits fibrinolysis
It is effective in reducing bleeding and mortality, although to different extents in trauma, peripartum, and surgical settings
It is generally safe and inexpensive with few adverse reactions, although further studies are needed to assess its safety in settings of high thromboembolic risk
A 33 year old woman in the fourth month of pregnancy is referred to the emergency department because of spontaneous massive antepartum haemorrhage. On admission her haemoglobin level has dropped to 7 g/dL and she is transfused with three packed red blood cell units. Her coagulation parameters are normal but sonography of the fetus reveals a formerly unknown placenta praevia. Bleeding stops immediately after placement into the vagina of a cotton swab soaked with a 1000 mg vial of tranexamic acid. In addition, on-demand oral therapy with tranexamic acid (1000 mg every eight hours) is prescribed at home during minor bleedings for the rest of the pregnancy, enabling successful delivery by caesarean section at week 31.
Acute haemorrhage
Haemorrhage is historically defined as the loss of 20% or more of the total blood volume (albeit recent definitions are more focused on haemodynamics1), which is associated with an increased risk of morbidity and mortality. The most common causes of severe blood loss include major surgery (especially cardiovascular, liver, and orthopaedic interventions), traumas, and the peripartum period.2 Postoperative, peripartum, and trauma related bleeding often requires blood transfusions which are lifesaving but have drawbacks, such as scarcity of units, the risk of mismatched transfusion, allergic reactions, transfusion related acute lung injury, and transfusion associated circulatory overload.2 To minimise the need for transfusions in patients with acute bleeding, several surgical procedures, anaesthetic techniques, and haemostatic medications have been developed. Among the haemostatic medications, tranexamic acid is one of the most …
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