Clinical Applications of Tranexamic Acid (TXA): Focus on Cardiovascular Patients Receiving Antithrombotic Agents

Tranexamic acid (TXA) is a synthetic antifibrinolytic agent that prevents fibrin clot degradation by inhibiting plasminogen activation. Widely used to reduce bleeding in trauma, surgery, and critical care, TXA has gained interest in cardiovascular patients receiving antithrombotic therapy due to their heightened bleeding risk. This review evaluates the mechanisms, safety, and clinical utility of TXA in this population. Evidence from randomized trials and systematic reviews supports TXA’s effectiveness in reducing blood loss and transfusion needs in trauma, cardiac surgery, orthopedic procedures, and intracranial hemorrhage. Early administration—particularly within 3 hours in trauma, and within 6 hours in Novel oral anticoagulant (NOAC)-associated intracranial bleeding—yields the most benefit. TXA generally does not increase thromboembolic complications, though high-dose use in cardiac surgery has been linked to seizures. Appropriately administered, TXA is a safe and cost-effective adjunct for bleeding control in cardiovascular patients on antithrombotic agents. While current data support its efficacy, further research is warranted to refine dosing strategies and to identify patient subgroups that may benefit most from its use.