Meta-Analysis Backs up TXA Safety in Patients at Risk of Thrombosis

Tranexamic acid (TXA) is safe to use to prevent bleeding in patients at the time of surgery, even in those at risk of thrombosis, according to Patrick Meybohm (University Hospital Würzburg, Germany).


During the ‘To Use or Not to Use’ session, Meybohm presented evidence from a recent meta-analysis that compared the use of TXA against placebo.1 The meta-analysis had included just over 200 trials and data on more than 125,000 patients. The results showed that there was no difference in the percentage of thromboembolic events between the groups, which occurred at respective rate of 2.1% and 2.0%. The meta-analysis had considered multiple types of thromboembolic events ­­­– from deep vein thrombosis and pulmonary embolism through to myocardial and cerebral infarctions and ischaemia.


Importantly, there was no risk in mortality, either overall or due to bleeding. In fact, there was a significant reduction seen with TXA use. This all points in favour of using TXA in our practices, Meybohm suggested in an interview ahead of his presentation.


“From a clinical point of view we see a lot of bleeding,” says Meybohm. Thus TXA is increasingly being used to control bleeding and to try and help patients who may be at greater risk of this complication.


“Our work now proves that TXA can be safely used for prevention of bleeding at the time of surgery,” Meybohm adds. “All the controversial discussion about side effects such as myocardial infarctions, stroke and thromboembolic events are not as important as a lot of people have been thinking,” he suggests.


As for the worry about thrombosis, “all of our patients receive prophylaxis for thrombosis, whether that is by mobilisation, heparin or low molecular weight heparin.”


Meybohm concedes that he may be preaching to the converted at the NATA Symposium. Nevertheless, the meta-analysis data can be useful to support the argument for TXA use in the patients that may need it. TXA is used in many European hospitals for pre-defined surgical procedures, such as joint replacement, prostate surgery, cardiac surgery, Caesarean section, trauma or anywhere there is any high risk of bleeding.       


The important point is that “we now have the data, from one of the largest studies ever to summarise the available data, to show that tranexamic acid is safe, and you can use it for all of your patients,” Meybohm summarises.



  1. Taeuber I, Weibel S, Herrmann E, et al. Association of intravenous tranexamic acid with thromboembolic events and mortality. A systematic review, meta-analysis, and meta-regression. JAMA Surg. 2021;156(6):e210884.

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