Tranexamic Acid for Patients with Hematological Disorders

Patients with hematological disorders are often thrombocytopenic due to the pathology of their disease and/or treatment. Platelet transfusions, used both therapeutically and prophylactically, only reduce clinically significant bleeding episodes from 50% to 43% of patients, so other treatments are often needed. In 2016 the Cochrane Library published a review of tranexamic acid (TXA) and another lysine analog—epsilon aminocaproic acid—for the prevention of bleeding in patients with hematological disorders based on four small randomized controlled trials (RCTs) with 86 participants in total. With the publication of four recent RCTs examining the use of lysine analogs for hematological disorders, the Cochrane Library updated their review to include eight RCTs with a total of 1041 participants. Based on six RCTs comparing TXA to placebo, TXA probably has little or no effect on WHO grade 2 bleeding or higher, grade 3 bleeding or higher, thromboembolism, mortality, or adverse events compared to placebo 30-days post-treatment (low to moderate certainty). There were insufficient data to make conclusions about other lysine analogs including epsilon aminocaproic acid. Additional treatments are needed to prevent and stop bleeding in patients with hematological disorders.

Reference:

Champaneria R, Estcourt LJ, Geneen L, Brunskill SJ, et al. Antifibrinolytics (lysine analogues) for the prevention of bleeding in people with haematological disorders. Cochrane Database Syst Rev. 2026 Feb 11;2:CD009733. doi: 10.1002/14651858.CD009733.pub4. PMID: 41670018.