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

Aug 12, 22
Evidencia y controversias sobre el ácido tranexámico: una revisión ilustrada / Tranexamic acid evidence and controversies: An illustrated review


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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You could be interested TXA en el campo: usos, protocolos y por qué debe considerarse para pacientes con shock y trauma / TXA in the field: Uses, protocols and why it should be considered for shock, trauma patients


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