Patients with hematologic malignancies account for 43% of the 2 million platelet doses transfused in the U.S. each year. Despite prophylactic platelet transfusions, 43% of patients with hematologic malignancies still experience WHO grade 2 bleeding or higher. Tranexamic acid (TXA) is commonly used to prevent bleeding and mortality in a many patients including orthopedic, cardiothoracic, organ transplant, trauma, and obstetrical. By blocking lysine binding sites on plasminogen, TXA stabilizes blood clots and prevents clots from being degraded. From 2016 to 2022, the A-TREAT (American Trial Using Tranexamic Acid in Thrombocytopenia) enrolled adult patients with hematological malignancies to determine the efficacy of TXA for patients with thrombocytopenia. During the study, 168 patients were randomized to receive TXA and 169 randomized to receive placebo three times daily for a maximum of 30 days when their platelet counts were below 30,000 per µL. Of 337 randomized patients, 330 received treatment when platelet counts fell below the cutoff—145 patients in the TXA arm and 144 patients in the placebo arm. No differences were observed in the treatment groups with respect to bleeding or transfusions. WHO grade 2 or higher bleeding was observed in 50.3% (73/145) and 54.2% (78/144) of the patients in the TXA arm and placebo arm, respectively. Furthermore, no differences were observed in the mean number of platelet transfusions or RBC transfusions during the 30-day follow-up period. Prophylactic tranexamic acid was not beneficial for patients with hematologic malignancies.
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