Fewer severe infections with tranexamic acid in patients with hematologic malignancies

Background Tranexamic acid (TXA) is an anti-fibrinolytic agent that reduces bleeding in a multitude of clinical settings from postpartum hemorrhage to trauma. TXA may have clinical effects unrelated to bleeding; plasminogen, the target of TXA, alters immune responses and TXA appears to decrease the risk of infection in patients undergoing cardiac surgery, as well as joint arthroplasty. Objectives To address whether TXA alters rates of infection and inflammatory outcomes in patients with hematologic malignancies. Methods We performed a post-hoc analysis of outcomes of patients randomized to receive either TXA or placebo in the double blinded, multicenter American Trial to Evaluate Tranexamic Acid Therapy in Thrombocytopenia (A-TREAT) (Clinicaltrials.gov Identifier: NCT02578901). Results TXA did not change the overall rate of infections, but the rate of severe infections (CTCAE grade 3+) was lower in patients who received TXA compared to the placebo group. Patients who experienced grade 3+ infections had higher rates of WHO grade 2+ bleeding and red blood cell transfusion requirements compared to patients who did not experience a grade 3+ infection, irrespective of treatment group. TXA did not impact other inflammatory outcomes such as mucositis, rash, or graft versus host disease. Conclusions Patients with hematologic malignancies who received TXA had less severe infections compared to those who received placebo with no difference in overall rate of infection or other inflammatory outcomes. Further investigation is needed on the impact of TXA on infections in this population.