Neurosurgery notes/Pharmacology/Anti-platelet-coagulation/Tranexamic acid (TXA)

Tranexamic acid (TXA)

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Anti-platelet-coagulation

Mechanism of action

  • Antifibrinolytic effects: blocking lysine binding sites on plasminogen molecules → inhibiting the interaction of plasminogen with formed plasmin and fibrin.

Evidence of use

  • Post trauma (CRASH 2)
    • Reduce mortality (all cause and bleeding related)
  • Post head injury (CRASH 3)
    • TXA is safe
    • TXA prevents expansion of small clots
    • TXA reduces mortality for mild to moderate head injury (GCS 9-15) patient that was given Less than 3 hrs after injury

Side effects

  • Ohashi et al 2015
    • TXA when in contact with nervous tissue can lead to inhibition of GABA receptors in cortical neurons causing
      • Seizure if in contact with cortical neurons
      • Pain-related phenomena, such as allodynia and hyperalgesia, If in contact with spinal cord

Meiadi et al 2021

  • For women taking TXA for heavy menstrual bleeding
  • The age-standardised incidence rate of venous thromboembolism was 11·8 (95% CI 4·6 to 30·2) per 10,000 person-years in oral tranexamic acid use compared to 2·5 (2·4 to 2·6) per 10,000 person-years in non-use.

Summary

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