antifibrinolytic agents


Summary: Agents that prevent fibrinolysis or lysis of a blood clot or thrombus. Several endogenous antiplasmins are known. The drugs are used to control massive hemorrhage and in other coagulation disorders.

Top Publications

  1. Greiff G, Stenseth R, Wahba A, Videm V, Lydersen S, Irgens W, et al. Tranexamic acid reduces blood transfusions in elderly patients undergoing combined aortic valve and coronary artery bypass graft surgery: a randomized controlled trial. J Cardiothorac Vasc Anesth. 2012;26:232-8 pubmed publisher
    ..0 [interquartile range, 2-5] v 5.0 [3-7], p = 0.049). Tranexamic acid reduced the number of packed red cell transfusions given to patients 70 years or older undergoing combined aortic valve replacement and CABG surgery. ..
  2. McConnell J, Shewale S, Munro N, Shah K, Deakin A, Kinninmonth A. Reduction of blood loss in primary hip arthroplasty with tranexamic acid or fibrin spray. Acta Orthop. 2011;82:660-3 pubmed publisher
    ..Blood loss was similar in the fibrin spray group and in the tranexamic acid group. identifier: NCT00378872. EudraCT identifier: 2006-001299-19. Regional Ethics Committee approval: 06/S0703/55, granted June 6, 2006. ..
  3. Gaberel T, Magheru C, Emery E, Derlon J. Antifibrinolytic therapy in the management of aneurismal subarachnoid hemorrhage revisited. A meta-analysis. Acta Neurochir (Wien). 2012;154:1-9; discussion 9 pubmed publisher
  4. Morrison J, Dubose J, Rasmussen T, Midwinter M. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg. 2012;147:113-9 pubmed publisher
    ..Treatment with TXA should be implemented into clinical practice as part of a resuscitation strategy following severe wartime injury and hemorrhage. ..
  5. Crescenti A, Borghi G, Bignami E, Bertarelli G, Landoni G, Casiraghi G, 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;343:d5701 pubmed publisher
    ..Trial registration identifier NCT00670345. ..
  6. Dhawale A, Shah S, Sponseller P, Bastrom T, Neiss G, Yorgova P, et al. Are antifibrinolytics helpful in decreasing blood loss and transfusions during spinal fusion surgery in children with cerebral palsy scoliosis?. Spine (Phila Pa 1976). 2012;37:E549-55 pubmed publisher
    ..Therapeutic comparative study...
  7. Zhang H, Chen J, Chen F, Que W. 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. 2012;20:1742-52 pubmed publisher
    ..TXA led to a significant reduction in the proportion of patients requiring blood transfusion. Therapeutic study (Systematic review of Level I studies with inconsistent results), Level II. ..
  8. Newton P, Bastrom T, Emans J, Shah S, Shufflebarger H, Sponseller P, et al. Antifibrinolytic agents reduce blood loss during pediatric vertebral column resection procedures. Spine (Phila Pa 1976). 2012;37:E1459-63 pubmed publisher
    ..Aprotinin has since been removed from the market. When normalized to patient size and levels excised, the use of TXA resulted in a reduction in intraoperative EBL. ..
  9. Yagi M, Hasegawa J, Nagoshi N, Iizuka S, Kaneko S, Fukuda K, et al. Does the intraoperative tranexamic acid decrease operative blood loss during posterior spinal fusion for treatment of adolescent idiopathic scoliosis?. Spine (Phila Pa 1976). 2012;37:E1336-42 pubmed publisher
    ..A multicenter randomized prospective analysis would provide additional information of the efficacy and safety of TXA. ..

More Information


  1. Alshryda S, Mason J, Sarda P, Nargol A, Cooke N, Ahmad H, et al. Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total hip replacement: a randomized controlled trial (TRANX-H). J Bone Joint Surg Am. 2013;95:1969-74 pubmed publisher
    ..Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. ..
  2. Alshryda S, Sarda P, Sukeik M, Nargol A, Blenkinsopp J, Mason J. Tranexamic acid in total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Br. 2011;93:1577-85 pubmed publisher
    ..The current evidence from trials does not support an increased risk of deep-vein thrombosis (13 trials, 801 patients) or pulmonary embolism (18 trials, 971 patients) due to TXA administration. ..
  3. Choo Y, Lee K, Yoon H, Qiu Y, Wan H, Sohn M, et al. Antifibrinolytic role of a bee venom serine protease inhibitor that acts as a plasmin inhibitor. PLoS ONE. 2012;7:e32269 pubmed publisher
  4. McCormack P. Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs. 2012;72:585-617 pubmed publisher
    ..Therefore, while high-quality published evidence is limited for some approved indications, tranexamic acid is an effective and well tolerated antifibrinolytic agent. ..
  5. Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ. 2012;344:e3054 pubmed publisher
    ..However, the effect of tranexamic acid on thromboembolic events and mortality remains uncertain. Surgical patients should be made aware of this evidence so that they can make an informed choice. ..
  6. Watts C, Pagnano M. Minimising blood loss and transfusion in contemporary hip and knee arthroplasty. J Bone Joint Surg Br. 2012;94:8-10 pubmed publisher
  7. Wind T, Barfield W, Moskal J. The effect of tranexamic acid on transfusion rate in primary total hip arthroplasty. J Arthroplasty. 2014;29:387-9 pubmed publisher
    ..001) while topical TXA failed to reach statistical significance (P=0.15). The transfusion rate without TXA was 19.86%, 4.39% with TXA infusion (odds ratio=5.36), and 12.86% (odds ratio=1.67) with topical TXA. ..
  8. Maniar R, Kumar G, Singhi T, Nayak R, Maniar P. Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res. 2012;470:2605-12 pubmed publisher
    ..The antifibrinolytic tranexamic acid reduces surgical blood loss, but studies have not identified an optimal regimen...
  9. Manji R, Grocott H, Leake J, Ariano R, Manji J, Menkis A, et al. Seizures following cardiac surgery: the impact of tranexamic acid and other risk factors. Can J Anaesth. 2012;59:6-13 pubmed publisher
    ..4 % vs 9.7 %, P = 0.001). Our data suggest that multiple risk factors, including TA, are associated with seizures after cardiac surgery. Thus, the TA dose may be a readily modifiable risk factor for postoperative seizures. ..
  10. Roberts I, Perel P, Prieto Merino D, Shakur H, Coats T, Hunt B, et al. Effect of tranexamic acid on mortality in patients with traumatic bleeding: prespecified analysis of data from randomised controlled trial. BMJ. 2012;345:e5839 pubmed publisher
    ..To assess the extent to which current protocols for treatment with tranexamic acid maximise benefits to patients...
  11. Zhou X, Tao L, Li J, Wu L. Do we really need tranexamic acid in total hip arthroplasty? A meta-analysis of nineteen randomized controlled trials. Arch Orthop Trauma Surg. 2013;133:1017-27 pubmed publisher
    ..However, high-quality randomized controlled trials are required to validate the results. ..
  12. Morrison J, Ross J, Dubose J, Jansen J, Midwinter M, Rasmussen T. Association of cryoprecipitate and tranexamic acid with improved survival following wartime injury: findings from the MATTERs II Study. JAMA Surg. 2013;148:218-25 pubmed publisher
    ..To quantify the impact of fibrinogen-containing cryoprecipitate in addition to the antifibrinolytic tranexamic acid on survival in combat injured...
  13. Ipema H, Tanzi M. Use of topical tranexamic acid or aminocaproic acid to prevent bleeding after major surgical procedures. Ann Pharmacother. 2012;46:97-107 pubmed publisher
    ..To evaluate the literature describing topical use of tranexamic acid or aminocaproic acid for prevention of postoperative bleeding after major surgical procedures...
  14. Konig G, Hamlin B, Waters J. Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty. J Arthroplasty. 2013;28:1473-6 pubmed publisher
    ..Topical application of TXA significantly reduces postoperative blood loss and transfusion risk in TKA and THA. ..
  15. Husted H, Blønd L, Sonne Holm S, Holm G, Jacobsen T, Gebuhr P. 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;74:665-9 pubmed
    ..Transemic acid is effective in reducing the postoperative blood loss, the total blood loss and the need for blood transfusion in primary total hip arthroplasty. ..
  16. Goobie S, Meier P, Pereira L, McGowan F, Prescilla R, Scharp L, et al. Efficacy of tranexamic acid in pediatric craniosynostosis surgery: a double-blind, placebo-controlled trial. Anesthesiology. 2011;114:862-71 pubmed publisher
    ..TXA is effective in reducing perioperative blood loss and transfusion requirement in children undergoing craniosynostosis reconstruction surgery. ..
  17. Colomina M, Bagó J, Vidal X, Mora L, Pellisé F. Antifibrinolytic therapy in complex spine surgery: a case-control study comparing aprotinin and tranexamic acid. Orthopedics. 2009;32:91 pubmed
    ..4% as compared to tranexamic acid, although statistical significance was not reached. The type of antifibrinolytic used did not have a significant impact on the main outcome variables of the study. ..
  18. Lawson J, Murphy M. Challenges for providing effective hemostasis in surgery and trauma. Semin Hematol. 2004;41:55-64 pubmed
    ..However, many of these agents have not yet been tested in clinical trials and studies are urgently needed to determine efficacy, safety, optimal dosage and time of administration. ..
  19. Martin K, Wiesner G, Breuer T, Lange R, Tassani P. The risks of aprotinin and tranexamic acid in cardiac surgery: a one-year follow-up of 1188 consecutive patients. Anesth Analg. 2008;107:1783-90 pubmed publisher
    ..Administration of aprotinin should be avoided in coronary artery bypass graft and high risk patients, whereas administration of tranexamic acid is not recommended in valve surgery. ..
  20. Garneti N, Field J. Bone bleeding during total hip arthroplasty after administration of tranexamic acid. J Arthroplasty. 2004;19:488-92 pubmed
    ..In the group that received tranexamic acid, a greater number of patients required transfusion than in the placebo group. The results of this study do not support the routine use of tranexamic acid in primary total hip arthroplasty. ..
  21. Molenaar I, Warnaar N, Groen H, TenVergert E, Slooff M, Porte R. Efficacy and safety of antifibrinolytic drugs in liver transplantation: a systematic review and meta-analysis. Am J Transplant. 2007;7:185-94 pubmed
    ..This systematic review and meta-analysis does not provide evidence for an increased risk of thromboembolic events associated with antifibrinolytic drugs in liver transplantation. ..
  22. Alvarez J, Santiveri F, Ramos I, Vela E, Puig L, Escolano F. Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied. Transfusion. 2008;48:519-25 pubmed
    ..No thromboembolic complications were detected. Tranexamic acid reduces blood losses and transfusion requirements even when a blood conservation program was used and it questions the usefulness of the postoperative reinfusion drains. ..
  23. Vanek T, Jares M, Fajt R, Straka Z, Jirasek K, Kolesar M, et al. Fibrinolytic inhibitors in off-pump coronary surgery: a prospective, randomized, double-blind TAP study (tranexamic acid, aprotinin, placebo). Eur J Cardiothorac Surg. 2005;28:563-8 pubmed
    ..001). Both tranexamic acid and aprotinin seem to be similarly effective in the reduction of postoperative blood loss in OPCAB. Tranexamic acid appears to be cost-effective and safe alternative to aprotinin. ..
  24. Fergusson D, Hebert P, Mazer C, Fremes S, MacAdams C, Murkin J, et al. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med. 2008;358:2319-31 pubmed publisher
    b>Antifibrinolytic agents are commonly used during cardiac surgery to minimize bleeding and to reduce exposure to blood products...
  25. Dietrich W, Spannagl M, Boehm J, Hauner K, Braun S, Schuster T, 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;107:1469-78 pubmed publisher
    ..Tranexamic acid seems to be less effective in operations with increased bleeding such as CABG. Clinical benefit depends on specific patient and institution characteristics ( NCT00396760). ..
  26. Mangano D, Tudor I, Dietzel C. The risk associated with aprotinin in cardiac surgery. N Engl J Med. 2006;354:353-65 pubmed
    ..The association between aprotinin and serious end-organ damage indicates that continued use is not prudent. In contrast, the less expensive generic medications aminocaproic acid and tranexamic acid are safe alternatives. ..
  27. 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;115:224-6 pubmed publisher
    ..To assess the effect of intravenous tranexamic acid on blood loss during and after cesarean delivery...
  28. Maddali M, Rajakumar M. Tranexamic acid and primary coronary artery bypass surgery: a prospective study. Asian Cardiovasc Thorac Ann. 2007;15:313-9 pubmed
    ..Post-bypass hemostasis was achieved faster, fibrinolysis was less, and there was no evidence of increased incidence of graft occlusion in the group given tranexamic acid. ..
  29. Shapiro F, Zurakowski D, Sethna N. Tranexamic acid diminishes intraoperative blood loss and transfusion in spinal fusions for duchenne muscular dystrophy scoliosis. Spine (Phila Pa 1976). 2007;32:2278-83 pubmed
    ..728 +/- 416 mL). TXA significantly reduces both intraoperative blood loss and the need for homologous transfusion of whole blood and packed red blood cells in DMD patients undergoing posterior spinal fusion for scoliosis. ..
  30. Shaw A, Stafford Smith M, White W, Phillips Bute B, Swaminathan M, Milano C, et al. The effect of aprotinin on outcome after coronary-artery bypass grafting. N Engl J Med. 2008;358:784-93 pubmed publisher
    ..56). Patients who received aprotinin had a higher mortality rate and larger increases in serum creatinine levels than those who received aminocaproic acid or no antifibrinolytic agent. ..
  31. Kuitunen A, Suojaranta Ylinen R, Kukkonen S, Niemi T. Tranexamic acid does not correct the haemostatic impairment caused by hydroxyethyl starch (200 kDa/0.5) after cardiac surgery. Blood Coagul Fibrinolysis. 2006;17:639-45 pubmed
    ..698, respectively). We conclude that after cardiopulmonary bypass, HES-induced impairment in clot formation and strength, or increased fibrinolytic capacity, is not reversed by the administration of tranexamic acid. ..
  32. Ray W, Stein C. The aprotinin story--is BART the final chapter?. N Engl J Med. 2008;358:2398-400 pubmed publisher
  33. Chen C, Wang C, Wang C, Lin T, Lin W, Liu S. Prospective, randomized, controlled trial of tranexamic acid in patients who undergo head and neck procedures. Otolaryngol Head Neck Surg. 2008;138:762-7 pubmed publisher
    ..We did not find a meaningful effect in reducing the drainage duration after head and neck procedures with the use of prophylactic tranexamic acid. ..
  34. Onodera T, Majima T, Sawaguchi N, Kasahara Y, Ishigaki T, Minami A. Risk of deep venous thrombosis in drain clamping with tranexamic acid and carbazochrome sodium sulfonate hydrate in total knee arthroplasty. J Arthroplasty. 2012;27:105-8 pubmed publisher
    ..Tranexamic acid and carbazochrome sodium sulfonate hydrate in the drain-clamping method help reduce bleeding after TKA without increasing the risk of deep venous thrombosis. ..
  35. Wong J, El Beheiry H, Rampersaud Y, Lewis S, Ahn H, De Silva Y, et al. Tranexamic Acid reduces perioperative blood loss in adult patients having spinal fusion surgery. Anesth Analg. 2008;107:1479-86 pubmed publisher
    ..TXA significantly reduced the estimated and calculated total amount of perioperative blood loss in adult patients having elective posterior thoracic/lumbar instrumented spinal fusion surgery. ..
  36. Adler Ma S, Brindle W, Burton G, Gallacher S, Hong F, Manelius I, et al. Tranexamic acid is associated with less blood transfusion in off-pump coronary artery bypass graft surgery: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2011;25:26-35 pubmed publisher
    ..A well-designed randomized controlled trial with an appropriate sample size is required to confirm tranexamic acid effectiveness and safety in off-pump CABG surgery. ..
  37. Yasim A, Aşik R, Atahan E. [Effects of topical applications of aprotinin and tranexamic acid on blood loss after open heart surgery]. Anadolu Kardiyol Derg. 2005;5:36-40 pubmed
    ..The differences were insignificant for effectiveness between aprotinin and tranexamic acid and for transfusion requirements. ..
  38. Kazemi S, Mosaffa F, Eajazi A, Kaffashi M, Daftari Besheli L, Bigdeli M, et al. The effect of tranexamic acid on reducing blood loss in cementless total hip arthroplasty under epidural anesthesia. Orthopedics. 2010;33:17 pubmed publisher
    ..Our study showed that administering tranexamic acid before the start of cementless THA under epidural anesthesia can reduce intraoperative and postoperative bleeding as well as need for blood transfusion. ..
  39. Lozano M, Basora M, Peidro L, Merino I, Segur J, Pereira A, et al. Effectiveness and safety of tranexamic acid administration during total knee arthroplasty. Vox Sang. 2008;95:39-44 pubmed publisher
    ..TA treatment was not associated with an increase in thromboembolic complications. Transfusion costs are significantly reduced. ..
  40. Andreasen J, Nielsen C. Prophylactic tranexamic acid in elective, primary coronary artery bypass surgery using cardiopulmonary bypass. Eur J Cardiothorac Surg. 2004;26:311-7 pubmed
  41. Florentino Pineda I, Thompson G, Poe Kochert C, Huang R, Haber L, Blakemore L. The effect of amicar on perioperative blood loss in idiopathic scoliosis: the results of a prospective, randomized double-blind study. Spine (Phila Pa 1976). 2004;29:233-8 pubmed
    ..The results have allowed us to reduce our recommendation for perioperative autologous blood donation, thereby further decreasing costs. ..
  42. Stein S, Halpern C, Reilly P. Upsetting the balance. Indian J Med Res. 2007;125:186-7 pubmed
  43. Claeys M, Vermeersch N, Haentjens P. Reduction of blood loss with tranexamic acid in primary total hip replacement surgery. Acta Chir Belg. 2007;107:397-401 pubmed
    ..Tranexamic acid 15 mg/kg given as a single preoperative bolus dose reduces postoperative and total blood loss, and packed cell transfusion requirements in primary total hip replacement surgery. ..
  44. Breuer T, Martin K, Wilhelm M, Wiesner G, Schreiber C, Hess J, et al. The blood sparing effect and the safety of aprotinin compared to tranexamic acid in paediatric cardiac surgery. Eur J Cardiothorac Surg. 2009;35:167-71; author reply 171 pubmed publisher
    ..There were fewer rethoracotomies and less postoperative red blood cell transfusion in patients who received aprotinin. ..
  45. Olenchock S, Lee P, Yehoshua T, Murphy S, Symes J, Tolis G. Impact of aprotinin on adverse clinical outcomes and mortality up to 12 years in a registry of 3,337 patients. Ann Thorac Surg. 2008;86:560-6; discussion 566-7 pubmed publisher
    ..The increased mortality may be related to higher concentrations of aprotinin received. ..
  46. Dadure C, Sauter M, Bringuier S, Bigorre M, Raux O, Rochette A, et al. Intraoperative tranexamic acid reduces blood transfusion in children undergoing craniosynostosis surgery: a randomized double-blind study. Anesthesiology. 2011;114:856-61 pubmed publisher
    ..There were no adverse events. In children undergoing surgical correction of craniosynostosis and pretreated with erythropoietin, intraoperative TXA reduces the transfusion requirement. ..
  47. Eubanks J. Antifibrinolytics in major orthopaedic surgery. J Am Acad Orthop Surg. 2010;18:132-8 pubmed
  48. Macgillivray R, Tarabichi S, Hawari M, Raoof N. Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty: a prospective, randomized double blind study. J Arthroplasty. 2011;26:24-8 pubmed publisher
    ..01). With use of an autologous reinfusion strategy, the lower dose is sufficient to lead to a lesser allogenic transfusion requirement. ..
  49. Murkin J. Lessons learned in antifibrinolytic therapy: The BART trial. Semin Cardiothorac Vasc Anesth. 2009;13:127-31 pubmed publisher
    ..This article will briefly review these developments with the hope of understanding how this abrupt turnabout took place and will attempt to understand how such events can be avoided in the future. ..
  50. Dietrich W. Aprotinin: 1 year on. Curr Opin Anaesthesiol. 2009;22:121-7 pubmed publisher
    ..This highlights the urgent need for independent clinical safety studies after the formal registration of a drug. ..
  51. Later A, Maas J, Engbers F, Versteegh M, Bruggemans E, Dion R, et al. Tranexamic acid and aprotinin in low- and intermediate-risk cardiac surgery: a non-sponsored, double-blind, randomised, placebo-controlled trial. Eur J Cardiothorac Surg. 2009;36:322-9 pubmed publisher
    ..5; p = 0.62) or other serious adverse events when compared with placebo. Aprotinin has clinically significant advantages over tranexamic acid in patients with normal renal function scheduled for low- or intermediate-risk cardiac surgery. ..
  52. Thompson G, Florentino Pineda I, Poe Kochert C. The role of amicar in decreasing perioperative blood loss in idiopathic scoliosis. Spine (Phila Pa 1976). 2005;30:S94-9 pubmed
    ..This results in less autologous blood donation, blood transfusion, costs, and complications. Its mechanism of action is uncertain but may be related to increased fibrinogen secretion. ..
  53. Chauhan S, Bisoi A, Kumar N, Mittal D, Kale S, Kiran U, et al. Dose comparison of tranexamic acid in pediatric cardiac surgery. Asian Cardiovasc Thorac Ann. 2004;12:121-4 pubmed
    ..Among the 4 groups given tranexamic acid, group D (triple dose) had the best results, followed by group E (double dose). Group B (single dose) had the worst results among the groups receiving tranexamic acid. ..