Hypofibrinolysis induced by tranexamic acid does not influence inflammation and mortality in a polymicrobial sepsis model

PLoS One. 2019 Dec 31;14(12):e0226871. doi: 10.1371/journal.pone.0226871. eCollection 2019.

Abstract

The biological relevance of fibrinolysis to the host response to sepsis is illustrated by pathogens such as S. pyogenes and Y. pestis, whose virulence factors are proteins that challenge the balance between pro- and anti-fibrinolytic factors of the host, and by the consistent finding of hypofibrinolysis in the early stages of sepsis. Whether this hypofibrinolytic response is beneficial or detrimental to the host, by containing the spread of pathogens while at the same time limiting the access of immune cell to infectious foci, is still a matter of debate. Tranexamic acid (TnxAc) is an antifibrinolytic agent that is being increasingly used to prevent and control bleeding in conditions such as elective orthopedic surgery, trauma, and post-partum-hemorrhage, which are frequently followed by infection and sepsis. Here we used a model of polymicrobial sepsis to evaluate whether hypofibrinolysis induced by TnxAc influenced survival, tissue injury and pathogen spread. Mice were treated with two doses of TnxAc bid for 48h, and then sepsis was induced by cecal ligation and puncture. Despite the induction of hypofibrinolysis by TnxAc, no difference could be observed in survival, tissue injury (measured by biochemical and histological parameters), cytokine levels or pathogen spread. Our results contribute with a new piece of data to the understanding of the complex interplay between fibrinolysis and innate immunity. While our results do not support the use of TnxAc in sepsis, they also address the thrombotic safety of TnxAc, a low cost and widely used agent to prevent bleeding.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antifibrinolytic Agents / pharmacology*
  • Antifibrinolytic Agents / therapeutic use
  • Biomarkers / metabolism
  • Cecum / surgery
  • Coinfection / drug therapy*
  • Cytokines / metabolism*
  • Disease Models, Animal
  • Fibrinolysis / drug effects*
  • Ligation
  • Male
  • Mice
  • Mice, Inbred C57BL
  • Sepsis / drug therapy*
  • Tranexamic Acid / pharmacology*
  • Tranexamic Acid / therapeutic use

Substances

  • Antifibrinolytic Agents
  • Biomarkers
  • Cytokines
  • Tranexamic Acid

Grants and funding

This work was funded by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) (www.capes.gov.br) - Finance Code 001 to YACN and was also funded by Sao Paulo Research Foundation (www.fapesp.br) grants # 2016/14172-6 and 2014/0984-3; and CNPq Brazil (www.cnpq.br) grant # 309317/2016; and FAEPEX-UNICAMP to EVDP. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.