Viscoelastic coagulation monitoring for tranexamic acid: personalised antifibrinolytic dosing?

Kenichi A Tanaka; Sharon M Bouvette; Amir L Butt

doi:10.1016/j.bja.2023.11.041

Viscoelastic coagulation monitoring for tranexamic acid: personalised antifibrinolytic dosing?

Br J Anaesth. 2024 Feb;132(2):227-229. doi: 10.1016/j.bja.2023.11.041. Epub 2023 Dec 19.

Authors

Kenichi A Tanaka¹, Sharon M Bouvette², Amir L Butt²

Affiliations

¹ Department of Anaesthesiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA. Electronic address: kenichi-tanaka@ouhsc.edu.
² Department of Anaesthesiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.

PMID: 38123441
DOI: 10.1016/j.bja.2023.11.041

Abstract

Ex vivo viscoelastic testing can be used to assess the concentration responses to tranexamic acid in blood samples obtained from pregnant women across the three trimesters and in non-pregnant controls. Minor variations in fibrinolysis across pregnancy suggest a target tranexamic acid blood concentration of 12.5 mg L^-1 for complete inhibition of fibrinolysis. Although the data support the potential utility of viscoelastic testing using the ClotPro® TPA test in maintaining therapeutic tranexamic acid concentrations during postpartum haemorrhage, it might obscure potentially crucial endogenous fibrinolysis inhibitor interactions essential to the microcirculation.

Keywords: coagulation; fibrinolysis; postpartum haemorrhage; tranexamic acid; viscoelastic testing.

Publication types

Editorial

MeSH terms

Antifibrinolytic Agents* / therapeutic use
Blood Coagulation* / drug effects
Female
Fibrinolysis
Humans
Pregnancy
Tranexamic Acid* / therapeutic use

Substances

Antifibrinolytic Agents
Tranexamic Acid