Tranexamic acid: still far to go

<span class="paragraphSection">Tranexamic acid (TXA), a synthetic lysine analogue, is a potent antifibrinolytic agent that inhibits both plasminogen and plasmin. Tranexamic acid gained worldwide recognition in the 2010 Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage (CRASH- 2) trial, a multinational randomized placebo-controlled trial of TXA in adult trauma patients with significant bleeding.<a href="#aew470-B1" class="reflinks">¹</a> TXA significantly reduced the risk of death as a result of bleeding by about a sixth and reduced the risk of all cause mortality by about a tenth. In 2011, TXA was recommended by the World Health Organization as an essential medicine for the treatment of acute bleeding in patients with trauma, cardiopulmonary bypass or postpartum haemorrhage.<a href="#aew470-B2" class="reflinks">²</a> The 2013 European guidelines recommended TXA in the prophylactic treatment of bleeding in major surgery to reduce perioperative blood loss and allogeneic blood transfusion.<a href="#aew470-B3" class="reflinks">³</a> The 2015 ASAs practice guidelines for perioperative blood management recommended consideration of TXA in surgical patients with excessive bleeding.<a href="#aew470-B4" class="reflinks">⁴</a> Tranexamic acid has consistently been shown to play an important role in blood conservation and to reduce perioperative blood loss in various settings, from trauma to cardiac, orthopaedic, neurological, craniofacial, obstetrical and gynaecological surgery.<a href="#aew470-B5" class="reflinks">⁵</a></span>

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