Abstract
Tranexamic acid (TXA) is an antifibrinolytic drug primarily used for reducing blood
loss in patients with major bleedings. Animal and cell studies have shown that TXA
might modulate the inflammatory response by either enhancing or inhibiting cytokine
levels. Furthermore, recent human studies have found altered inflammatory biomarkers
in patients receiving TXA when compared with patients who did not receive TXA. In
this systematic review we investigated the effect of TXA on inflammatory biomarkers
in different patient groups. A systematic literature search was conducted on the databases
PubMed and Embase to identify all original articles that investigated inflammatory
biomarkers in patients receiving TXA and compared them to a relevant control group.
The review was performed according to the PRISMA guidelines, and the literature search
was performed on November 29, 2021. Thirty-three studies were included, among which
14 studies compared patients receiving TXA with patients getting no medication, another
14 studies investigated different dosing regimens of TXA, and finally five studies
examined the administration form of TXA. The present review suggests that TXA has
an anti-inflammatory effect in patients undergoing orthopaedic surgery illustrated
by decreased levels of C-reactive protein and interleukin-6 in patients receiving
TXA compared with patients receiving no or lower doses of TXA. However, the anti-inflammatory
effect was not found in patients undergoing cardiac surgery, pediatric craniosynostosis
patients, or in rheumatoid arthritis patients. The inflammatory response was not affected
by administration form of TXA (oral, intravenous, or topical). In conclusion, an anti-inflammatory
effect of TXA was consistently found among orthopaedic patients only.
Keywords
tranexamic acid - inflammation - antiinflammation - antifibrinolytics
