Tranexamic Acid Inhibits Fibrinolysis, Shortens the Bleeding Time and Improves Platelet Function in Patients with Chronic Renal Failure

Diego Mezzano; Olga Panes; Blanca Muñoz; Edgar Pais; Rodrigo Tagle; Fernando González; Sergio Mezzano; Francisco Barriga; Jaime Pereira

doi:10.1055/s-0037-1614370

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1999; 82(04): 1250-1254
DOI: 10.1055/s-0037-1614370

Review Article

Schattauer GmbH

Tranexamic Acid Inhibits Fibrinolysis, Shortens the Bleeding Time and Improves Platelet Function in Patients with Chronic Renal Failure

Diego Mezzano

¹From the Departments of Hematology-Oncology and Hematology-Oncology and Nephrology, School of Medicine, Catholic University of Chile

,

Olga Panes

¹From the Departments of Hematology-Oncology and Hematology-Oncology and Nephrology, School of Medicine, Catholic University of Chile

,

Blanca Muñoz

¹From the Departments of Hematology-Oncology and Hematology-Oncology and Nephrology, School of Medicine, Catholic University of Chile

,

Edgar Pais

²Departments of Hematology-Oncology and Nephrology, School of Medicine, Catholic University of Chile and Departments of Nephrology, Schools of Medicine, University of Chile and Austral

,

Rodrigo Tagle

²Departments of Hematology-Oncology and Nephrology, School of Medicine, Catholic University of Chile and Departments of Nephrology, Schools of Medicine, University of Chile and Austral

,

Fernando González

³Departments of Hematology-Oncology and Nephrology, School of Medicine, University of Chile and Austral

,

Sergio Mezzano

⁴Departments of Hematology-Oncology and Nephrology, School of Medicine, University of Chile

,

Francisco Barriga

¹From the Departments of Hematology-Oncology and Hematology-Oncology and Nephrology, School of Medicine, Catholic University of Chile

,

Jaime Pereira

¹From the Departments of Hematology-Oncology and Hematology-Oncology and Nephrology, School of Medicine, Catholic University of Chile

› Author Affiliations

Abstract

Summary

Background: A defect in platelet function is the main determinant of the prolonged bleeding time in chronic renal failure (CRF). We previously reported a significant correlation between platelet abnormalities and elevated plasma markers of plasmin and thrombin generation. Our aim was to explore the effect of inhibiting both plasmin action with tranexamic acid (TA) and thrombin production with low molecular weight heparin (LMWH), on the bleeding time (BT) and platelet function in patients with CRF. Methods: 37 patients with CRF (mean creatinine 8.6 ± 4.4 mg/dl) under conservative treatment, with prolonged BT, entered this study and received TA during 6 days, with (n = 24) and without LMWH (n = 13). BT, platelet aggregation/secretion, platelet granule contents, von Willebrand factor and parameters of coagulation and fibrinolysis were recorded before and at the end of treatment. Results: The BT was shortened in 26/37 (67%) patients. This effect was associated with significant improvement of platelet aggregation and secretion, with decrease to a normal range of fibrin/fibrinogen degradation products, mild increase in plasmin-antiplasmin complexes and pronounced reduction of circulating plasminogen. No differences were seen among patients with or without LMWH. No serious side effects or complications were observed. Interpretation: These findings indicate that the activation of fibrinolysis plays a significant role in the defect of primary hemostasis in patients with CRF. Inhibition of plasmin activity with TA shortens the BT and improves platelet function in the majority of patients with severe disease.

Full Text

References

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