Department of Surgery, Regions Hospital, Saint Paul, Minnesota.
Department of Surgery, University of Texas at Tyler School of Medicine, Tyler, Texas.
J Surg Res. 2024 Oct;302:208-221. doi: 10.1016/j.jss.2024.07.042. Epub 2024 Aug 5.
Tranexamic acid (TXA) is a potent antifibrinolytic drug that inhibits the activation of plasmin by plasminogen. While not a new medication, TXA has quickly gained traction across a variety of surgical subspecialties to prevent and treat bleeding. Knowledge on the use of this drug is essential for the modern surgeon to continue to provide excellent care to their patients.
A comprehensive review of the PubMed database was conducted of articles published within the last 10 y (2014-2024) relating to TXA and its use in various surgical subspecialties. Seminal studies regarding the use of TXA older than 10 y were included from the author's archives.
Indications for TXA are not limited to trauma alone, and TXA is utilized across a variety of surgical subspecialties from neurosurgery to hepatic surgery to control hemorrhage. Overall, TXA is well tolerated with common dose-dependent adverse effects, including headache, nasal symptoms, dizziness, nausea, diarrhea, and fatigue. More severe adverse events are rare and easily mitigated by not exceeding a dose of 50 mg/kg.
The administration of TXA as an adjunct to treat trauma saves lives. The ability of TXA to induce seizures is dose dependent with identifiable risk factors, making this serious adverse effect predictable. As for the potential for TXA to cause thrombotic events, uncertainty remains. If this association is proven to be real, the risk will likely be small, since the use of TXA is still advantageous in most situations because of its efficacy for a more common concern, bleeding.
氨甲环酸（TXA）是一种有效的纤维蛋白溶解抑制剂，可抑制纤溶酶原转化为纤溶酶。尽管氨甲环酸不是一种新药，但它已迅速在多个外科亚专科中得到应用，以预防和治疗出血。了解这种药物的使用对于现代外科医生继续为患者提供卓越的护理至关重要。
对过去 10 年（2014-2024 年）发表的与 TXA 及其在各种外科亚专科中的应用相关的 PubMed 数据库文章进行了全面综述。从作者的档案中纳入了关于氨甲环酸使用的超过 10 年的重要研究。
氨甲环酸的适应证不仅限于创伤，它还广泛应用于神经外科、肝脏外科等多种外科亚专科，用于控制出血。总体而言，氨甲环酸耐受性良好，常见的剂量依赖性不良反应包括头痛、鼻症状、头晕、恶心、腹泻和疲劳。更严重的不良反应较为罕见，通过不超过 50mg/kg 的剂量即可轻易缓解。
作为辅助治疗创伤的 TXA 给药可挽救生命。TXA 引起癫痫的可能性与剂量有关，存在可识别的危险因素，使这种严重不良反应具有可预测性。至于 TXA 引起血栓事件的潜在风险，目前仍存在不确定性。如果这种关联被证明是真实的，那么这种风险可能很小，因为在大多数情况下，由于其在更常见的出血问题上的疗效，TXA 的应用仍然具有优势。
