Tranexamic acid in life threatening haematuria
Date First Published:
August 15, 2014
Last Updated:
March 11, 2015
Report by:
Dr Peter Hulme, ST6 (Manchester Royal Infirmary, Manchester, UK)
Search checked by:
Katharine Wylie, Manchester Royal Infirmary, Manchester, UK
Three-Part Question:
In [patients with life threatening haematuria] does [tranexamic acid] [improve outcomes]
Clinical Scenario:
A 70yr old man is rushed into resus with a BP of 60/30. He has been passing blood and clots in the urine for the last 24 hours. As you commence fluid resuscitation you wonder whether tranexamic acid may have a role in his manageemnt
Search Strategy:
Medline using NHS evidence date of searching 20 November 2014: [exp tranexamic acid/OR tranexamic AND acid.ti,ab OR txa.ti,ab] AND [exp hematuria/ OR haematuria. ti, ab].
Embase using NHS evidence SAFETY SEARCH: [*tranexamic acid/] AND [*hematuria/OR haematuria. ti, ab].
The Cochrane Library Issue 11 of 12, November 2014: MeSH descriptor: [Tranexamic Acid] explode all trees AND MeSH descriptor: [Hematuria] explode all trees.
Embase using NHS evidence SAFETY SEARCH: [*tranexamic acid/] AND [*hematuria/OR haematuria. ti, ab].
The Cochrane Library Issue 11 of 12, November 2014: MeSH descriptor: [Tranexamic Acid] explode all trees AND MeSH descriptor: [Hematuria] explode all trees.
Outcome:
Sixteen papers were found, of which four provided the best evidence to answer the question
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| A successful treatment of life-threatening bleeding from polycystic kidneys with antifibrinolytic agent tranexamic acid. Vujkovac B.,Sabovic M. 2006 Slovenia | One patient with autosomal dominant polycystic kidney disease (ADPKD) | Case report | Nephrectomy | Bilateral Nephrectomies avoided | Case report. |
| Thromboembolism | Ureters obstructed by clots requiring J stents | ||||
| Mortality | Patient survived | ||||
| Medical therapy with tranexamic acid in autosomal dominant polycystic kidney disease patients with severe haematuria. Peces R, Aguilar A, Vega C, et al. 2012 Spain | 8 patients with autosomal dominant polycystic kidney disease (ADPKD) | Prospective observational study | Cessation of haematuria | Stopped within 2-5 days in all patients | Only 8 patients. All patients had ADPKD. |
| Renal function | Remained stable | ||||
| Haemoglobin | Remained stable | ||||
| Mortality | All patients survived | ||||
| Thromboembolism | No cases of thromboemblism | ||||
| Tranexamic Acid Treatment of Life-Threatening Hematuria in Polycystic Kidney Disease. AlAmeel T, West M. 2011 Canada | One patient with autosomal dominant polycyctic kidney disease (ADPKD) with recurrent episodes of life threatening haematuria. | Case report | Haematuria | Stopped within 24-36hrs | Case report. |
| Renal function | Improved to baseline | ||||
| Thromboembolism | No incidence of thromboembolism | ||||
| Mortality | Patient survived | ||||
| Oral tranexamic acid as a novel treatment option for persistent haematuria in patients with sickle cell disease. Davies NF, McGuire BB, Lawlor L, et al. 2010 Ireland | Female patient with sickle cell anaemia and haematuria requiring blood transfusion | Case report | Haematuria | Stopped within 4 days of treatment | Case report. |
| Haemoglobin | Remained stable | ||||
| Mortality | Patient survived | ||||
| Thromboembolism | No incidence of thromboembolism |
Author Commentary:
The evidence for the use of tranexamic acid in life-threatening haematuria is weak and predominantly in patients with autosomal-dominant polycystic kidney disease. The case reports do suggest a benefit, but larger studies are needed to prove this benefit and exclude the increased risk of thromboembolic complications.
Bottom Line:
The evidence is limited, but there may be a role for tranexamic acid in life-threatening haematuria, particularly in patients with autosomal-dominant polycystic kidney disease.
References:
- Vujkovac B.,Sabovic M.. A successful treatment of life-threatening bleeding from polycystic kidneys with antifibrinolytic agent tranexamic acid.
- Peces R, Aguilar A, Vega C, et al.. Medical therapy with tranexamic acid in autosomal dominant polycystic kidney disease patients with severe haematuria.
- AlAmeel T, West M.. Tranexamic Acid Treatment of Life-Threatening Hematuria in Polycystic Kidney Disease.
- Davies NF, McGuire BB, Lawlor L, et al.. Oral tranexamic acid as a novel treatment option for persistent haematuria in patients with sickle cell disease.