Intra-operative tranexamic acid: A standard of care?

Peri-operative bleeding is a major cause of morbidity and mortality in patients undergoing surgery. Tranexamic acid, an antifibrinolytic agent, is effective for prevention and treatment of bleeding in a variety of different surgical populations. This review summarizes the evidence supporting the use of tranexamic acid in major surgical settings including cardiac surgery, obstetrics, orthopedic surgery, and non-cardiac surgery. We discuss potential adverse effects with use of tranexamic acid including the theoretical risk of thrombosis. Lastly, we discuss other potential benefits of tranexamic acid including prevention of infection and maintenance of blood-brain barrier integrity.