Evidencia y controversias sobre el ácido tranexámico: una revisión ilustrada / Tranexamic acid evidence and controversies: An illustrated review

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1. Tranexamic acid evidence and controversies: An illustrated review


TXA ILLUSTRATED REVIEW

Tranexamic acid evidence and controversies: An illustrated review

Nicole Relke MD,Nicholas L. J. Chornenki MD,Michelle Sholzberg MDCM, MSc, FRCPC

First published: 14 July 2021 https://doi.org/10.1002/rth2.12546Citations: 3

Handling Editor: Alisa Wolberg.



Resumen
El ácido tranexámico (TXA) es un agente antifibrinolítico comúnmente utilizado para el tratamiento o prevención de hemorragias. Las indicaciones para TXA son diversas, incluyendo sangrado menstrual abundante, traumatismo, hemorragia posparto, lesión cerebral traumática y sangrado en el sitio quirúrgico. A pesar de décadas de uso y un sólido cuerpo de evidencia, las dudas sobre el uso de TXA persisten en muchos entornos clínicos. Esta revisión ilustrada describe la historia, la farmacología y las consideraciones prácticas del uso de TXA. También describimos los principales ensayos controlados aleatorizados de TXA y sus implicaciones. Finalmente, revisamos la evidencia sobre controversias comunes en torno al ATX, como el riesgo de trombosis, la prescripción junto con anticonceptivos hormonales combinados y el uso en pacientes con hematuria macroscópica.

Esenciales
El ácido tranexámico (TXA) disminuye el riesgo de sangrado y, a menudo, el riesgo de muerte por sangrado.
En general, TXA no aumenta el riesgo de coágulos de sangre.
Considere la posibilidad de tomar decisiones compartidas en pacientes que toman ATX y anticonceptivos hormonales combinados.
Se desconoce si el TXA causa daño en pacientes con sangre en la orina.

Abstract
Tranexamic acid (TXA) is an antifibrinolytic agent commonly used for the treatment or prevention of bleeding. Indications for TXA are diverse, including heavy menstrual bleeding, trauma, postpartum hemorrhage, traumatic brain injury, and surgical site bleeding. Despite decades of use and a robust body of evidence, hesitancy using TXA persists in many clinical settings. This illustrated review describes the history, pharmacology, and practical considerations of TXA use. We also describe the major landmark randomized controlled trials of TXA and their implications. Finally, we review the evidence around common controversies surrounding TXA such as the risk of thrombosis, prescription along with combined hormonal contraceptives, and use in patients with gross hematuria.

Essentials
Tranexamic acid (TXA) decreases the risk of bleeding and often the risk of death from bleeding.
In general, TXA does not increase the risk of blood clots.
Consider shared decision making in patients taking TXA and combined hormonal contraceptives.
It is unknown if TXA causes harm in patients with blood in the urine.












ACKNOWLEDGMENTS

Select images in this review were taken from https://smart.servier.com and are licensed under a Creative Commons Attribution 3.0 Unported License. Blood drop image (pages 1, 4-5, 9-11) was purchased from shutterstock (stock vector ID: 641207020)

RELATIONSHIP DISCLOSURE

The authors declare no conflicts of interest.

AUTHOR CONTRIBUTIONS

NR and MS conceived and designed the manuscript. NR, NLJC, and MS wrote the paper.



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Citing Literature

Number of times cited according to CrossRef: 3

Stephanie G. Lee, John Fralick, Christopher J. D. Wallis, Monica Boctor, Michelle Sholzberg, Michael Fralick, Systematic review of hematuria and acute renal failure with tranexamic acid, European Journal of Haematology, 10.1111/ejh.13762, 108, 6, (510-517), (2022).

Wiley Online Library

Sarah Nersesian, Michelle Sholzberg, Mary Cushman, Alisa S. Wolberg, The Journey to a Successful Illustrated Review, Research and Practice in Thrombosis and Haemostasis, 10.1002/rth2.12721, 6, 4, (2022).

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Giuliana D’Aulerio, Nagendra N. Dudi‐Venkata, Chris Varghese, Uyen G. Vo, Peter Pockney, Toby Richards, David I. Watson, Deborah Wright, Doug Robb, Liam Ferguson, Jana‐Lee Moss, William Xu, Bridget Hwang, Laure Taher Mansour, Warren Seow, Scott Gelzinnis, Joel Seto, Cameron I. Wells, José Antonio García‐Erce, James Glasbey, Sivesh K. Kamarajah, Kenneth McLean, Ane Abad Motos, Francesco Pata, Gianluca Pellino, Javier Ripolles, Postoperative variations in anaemia treatment and transfusions (POSTVenTT): protocol for a prospective multicentre observational cohort study of anaemia after major abdominal surgery, Colorectal Disease, 10.1111/codi.15902, 24, 2, (228-234), (2021).

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