Depth of Anesthesia

36. Does tranexamic acid increase the risk of thromboembolism?

Dec 6, 2023
Guest
Pavan Bendapudi
Guest
Zach Cost
Dr. Zach Cost, an anesthesia resident at Massachusetts General Hospital, and Dr. Pavan Bendapudi, assistant professor at Harvard Medical School, delve into tranexamic acid (TXA) and its relationship with thromboembolic risk. They dissect the clash between TXA's hemostatic benefits and potential dangers, referencing pivotal studies like CRASH-2. Their conversation also covers differentiating TXA from Amicar regarding efficacy and risks, while exploring its effectiveness in surgery and the complexities surrounding antifibrinolytic therapy.
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INSIGHT

TXA Mechanism of Action

  • TXA (tranexamic acid) is a hemostatic agent that resembles lysine.
  • It inhibits plasminogen, reducing bleeding by blocking its binding to fibrin clots.
ANECDOTE

TXA's Discovery

  • TXA was discovered in 1960s Japan by Drs. Utako and Shusuke Okamoto.
  • Dr. Utako Okamoto initially researched the cerebellum but shifted to blood research due to resource scarcity.
INSIGHT

TXA vs. Aprotinin

  • TXA's theoretical risk involves potential clot propagation, unlike aprotinin.
  • Aprotinin, a serine protease inhibitor, was removed from the market due to increased cardiovascular events.
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