There wasn’t enough proof to support the preventive use of tranexamic acid (TXA) in thrombocytopenia. A randomized, double-blind clinical trial was carried out from June 2016 to June 2020 to find out whether TXA safely lowers bleeding incidence in patients receiving therapy for hematologic malignancies.

About 356 patients were eligible and enrolled, and 337 participants (mean age, 53.9; 141 [41.8%] women) were randomly assigned to receive either 1,300 mg of TXA orally or 1,000 mg of TXA through IV (n = 168) versus placebo (n = 169) three times daily for a maximum of 30 days out of 3,120 adults who underwent screening. When the platelet count dropped below 30,000/µL, 330 patients were activated; 279 (83%) had full outcome ascertainment.

World Health Organization (WHO) grade more or around 2 bleeding was seen in 50.3% (73/145) & 54.2% (78/144) of patients in the TXA & placebo groups, respectively, in the 30 days after activation, with an adjusted odds ratio of 0.83 (95% CI, 0.50-1.34; P =.44). The average number of platelet transfusions, the average number of days without grade more or around 2 bleeding (mean difference, 0.8; 95% CI, −0.4 to 2.0), the average number of thrombotic events (6/163 [3.7%] TXA, 9/163 [5.5%] placebo), and the average number of serious bleeding-related deaths were not statistically different. The most frequent adverse reactions included diarrhea (116/164 [70.7%] TXA & 114/163 [69.9%] placebo), febrile neutropenia (111/164 [67.7%] TXA & 105/163 [64.4%] placebo), tiredness (106/164 [64.6%] TXA & 109/163 [66.9%] placebo), & nausea (104/164 [63.4%] TXA & 97/163 [59.

In hematologic malignancy patients receiving chemotherapy or hematopoietic stem cell transplantation, preventive treatment with TXA did not substantially lower the incidence of WHO grade ≥2 hemorrhages when compared to placebo.

Reference: ashpublications.org/blood/article/140/11/1254/485476/Prophylactic-tranexamic-acid-in-patients-with