title: Tranexamic acid: from trauma to routine perioperative use.
abstract: OBJECTIVE
  Optimizing hemostasis with antifibrinolytics is becoming a common surgical practice. Large clinical studies have demonstrated efficacy and safety of tranexamic acid (TXA) in the trauma population to reduce blood loss and transfusions. Its use in patients without pre-existing coagulopathies is debated, as thromboembolic events are a concern. In this review, perioperative administration of TXA is examined in nontrauma surgical populations. Additionally, risk of thromboembolism, dosing regimens, and timing of dosing are assessed.
  
  
  RESULTS
  Perioperative use of TXA is associated with reduced blood loss and transfusions. Thromboembolic effects do not appear to be increased. However, optimal dosing and timing of TXA administration is still under investigation for nontrauma surgical populations.
  
  
  CONCLUSIONS
  As part of a perioperative blood management programme, TXA can be used to help reduce blood loss and mitigate exposure to blood transfusion.
authors: aAnesthesia Services Division, Trauma Section, UAB Department of Anesthesiology, Birmingham, Alabama bDivision of Trauma Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, and Perfusion and Cell Salvage Services, R Adams Cowley Shock Trauma Center, Baltimore, Maryland cCritical Care Division, Department of Anesthesiology, and Surgery and Cell Biology, Center for Lung Injury and Repair, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors: Jeff
authors: J
authors: Simmons
authors: Robert A
authors: RA
authors: Sikorski
authors: Jean-Francois
authors: JF
authors: Pittet
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000188:drug therapy; D006487:Hemostasis; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D014148:Tranexamic Acid / Q000627:therapeutic use*; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
references: J Laryngol Otol. 2014 Jul;128(7):574-9
references: 25017453
references: Anesth Analg. 2013 Oct;117(4):760-2
references: 24057950
references: J Trauma. 2008 Oct;65(4):748-54
references: 18849786
references: Asian Cardiovasc Thorac Ann. 2014 Nov;22(9):1039-45
references: 24637029
references: Transfusion. 2013 Jan;53 Suppl 1:28S-37S
references: 23301970
references: Arch Surg. 2012 Feb;147(2):113-9
references: 22006852
references: Semin Hematol. 2013 Jul;50(3):259-69
references: 23953343
references: Transplant Proc. 2012 Jul-Aug;44(6):1523-5
references: 22841202
references: BMC Res Notes. 2013;6:184
references: 23651507
references: Anesthesiology. 2014 Mar;120(3):590-600
references: 23903022
references: Injury. 2012 Jan;43(1):22-5
references: 21145056
references: J Trauma Acute Care Surg. 2012 Jul;73(1):13-9
references: 22743367
references: J Trauma Acute Care Surg. 2012 Jul;73(1):60-6
references: 22743373
references: Scand J Surg. 2014 Apr 28;103(2):81-88
references: 24777616
references: Cochrane Database Syst Rev. 2013;1:CD010245
references: 23440847
references: J Trauma. 2003 Jul;55(1):39-44
references: 12855879
references: PLoS One. 2011;6(8):e23530
references: 21886795
references: Transfusion. 2013 Jan;53 Suppl 1:23S-27S
references: 23301969
references: Pflugers Arch. 2007 Jun;454(3):345-59
references: 17256154
references: Shock. 2009 Dec;32(6):659-65
references: 19333141
references: Acta Anaesthesiol Scand. 2014 Oct;58(9):1075-85
references: 25069636
references: Ann Surg. 2007 May;245(5):812-8
references: 17457176
references: Lancet. 2011 Mar 26;377(9771):1096-101, 1101.e1-2
references: 21439633
references: Ann Pharmacother. 2014 Dec;48(12):1563-9
references: 25214649
references: Curr Opin Crit Care. 2007 Dec;13(6):680-5
references: 17975390
references: Surg Clin North Am. 2012 Aug;92(4):877-91, viii
references: 22850152
references: Br J Anaesth. 2013 Dec;111(6):916-24
references: 23880099
references: J Vasc Surg. 2014 May;59(5):1203-8
references: 24440679
references: J Am Coll Surg. 2012 May;214(5):739-46
references: 22520693
references: J Trauma Acute Care Surg. 2014 Feb;76(2):255-6; discussion 262-3
references: 24458031
references: Med Hypotheses. 2010 Dec;75(6):564-7
references: 20708846
references: JAMA Surg. 2013 Feb;148(2):127-36
references: 23560283
references: PLoS One. 2013;8(2):e55436
references: 23424632
references: Lancet. 2010 Jul 3;376(9734):23-32
references: 20554319
references: J Arthroplasty. 2014 Feb;29(2):387-9
references: 23790499
references: Transfusion. 2014 Jan;54(1):31-41
references: 23614539
references: ScientificWorldJournal. 2012;2012:821794
references: 22547997
references: BMJ. 2014;349:g4934
references: 25122635
references: BMJ. 2014;349:g4829
references: 25116268
references: Anesth Analg. 2012 Aug;115(2):239-43
references: 21737704
references: Crit Care. 2011;15(6):R272
references: 22087841
references: Thromb Haemost. 2001 Jun;85(6):958-65
references: 11434702
references: Scand J Trauma Resusc Emerg Med. 2012;20:27
references: 22490186
references: Minerva Anestesiol. 2014 Oct;80(10):1115-22
references: 24287671
references: J Neurotrauma. 2014 Feb 15;31(4):404-10
references: 24040968
references: Anaesthesia. 2010 Feb;65(2):199-203
references: 19995349
references: J Trauma. 2008 May;64(5):1211-7; discussion 1217
references: 18469643
references: J Trauma Acute Care Surg. 2013 Jul;75(1 Suppl 1):S40-7
references: 23778510
references: Br J Haematol. 2005 May;129(3):307-21
references: 15842654
references: Br J Anaesth. 2013 Oct;111(4):549-63
references: 23661406
references: Curr Opin Anaesthesiol. 2012 Apr;25(2):229-34
references: 22270921
references: J Thromb Haemost. 2012 Jul;10(7):1342-51
references: 22519961
references: Transfus Med Rev. 2012 Jan;26(1):1-13
references: 21872428
references: Ann Surg. 2012 Feb;255(2):379-85
references: 22133894
references: Crit Care. 2013;17(4):R137
references: 23849249
references: J Craniomaxillofac Surg. 2014 Oct;42(7):1221-4
references: 24776218
references: Ann Surg. 2011 Aug;254(2):194-200
references: 21772125
references: Scand Cardiovasc J. 2012 Aug;46(4):194-202
references: 22375889
references: Arterioscler Thromb Vasc Biol. 2006 Jan;26(1):41-8
references: 16254201
references: Scand J Trauma Resusc Emerg Med. 2013;21:56
references: 23867061
references: J Clin Diagn Res. 2014 May;8(5):ZC06-8
references: 24995234
references: J Arthroplasty. 2014 Apr;29(4):733-5
references: 24184325
references: Curr Opin Crit Care. 2012 Dec;18(6):641-6
references: 23090566
references: J Trauma Acute Care Surg. 2013 Jun;74(6):1575-86
references: 23694890
references: JAMA Surg. 2013 Mar;148(3):218-25
references: 23670117