ISSN: 1859 - 2872
Vai trò, nguy cơ và ứng dụng lâm sàng hiện nay của axit tranexamic trong phẫu thuật ngoài tim
Main Article Content
Keywords
Axit tranexamic, tiêu sợi huyết, chảy máu, phẫu thuật ngoài tim
Tóm tắt
Chảy máu khối lượng lớn là một trong những nguyên nhân chính gây biến chứng và tử vong ở bệnh nhân phẫu thuật. Axit tranexamic (TXA) là một thuốc chống tiêu sợi huyết mạnh, đã được sử dụng thường quy trong phẫu thuật tim nhằm dự phòng chảy máu. Tuy nhiên, việc sử dụng TXA trong phẫu thuật ngoài tim vẫn bị hạn chế do lo ngại các nguy cơ bất lợi như hình thành huyết khối gây tắc mạch hoặc co giật, đặc biệt ở những bệnh nhân có nguy cơ cao. Bài tổng quan này trình bày cơ chế tác dụng, vai trò, nguy cơ và ứng dụng hiện nay của TXA trong phẫu thuật ngoài tim nhằm cung cấp cơ sở khoa học cho việc sử dụng TXA trong thực hành lâm sàng, góp phần kiểm soát chảy máu trong và sau phẫu thuật hiệu quả và an toàn.
Article Details
Các tài liệu tham khảo
1. Grocott MPW, Murphy M, Roberts I, Sayers R, Toh CH (2022) Tranexamic acid for safer surgery: the time is now. Br J Anaesth 129(4): 459-461. doi:10.1016/j.bja.2022.06.024
2. Tian L, Li X, He L, Ji H, Yao Y (2024) Hemostatic effects of tranexamic acid in cardiac surgical patients with antiplatelet therapy: A systematic review and meta-analysis. Perioper Med (Lond) 13(1):58. doi:10.1186/s13741-024-00418-3
3. Roberts I, Murphy MF, Moonesinghe R et al (2024) Wider use of tranexamic acid to reduce surgical bleeding could benefit patients and health systems. Bmj 385: 079444. doi:10.1136/bmj-2024-079444
4. Ockerman A, Vanassche T, Garip M et al (2021) Tranexamic acid for the prevention and treatment of bleeding in surgery, trauma and bleeding disorders: A narrative review. Thromb J 19(1): 54. doi:10.1186/s12959-021-00303-9
5. Marcucci M, Duceppe E, Le Manach Y et al (2020) Tranexamic acid and rosuvastatin in patients at risk of cardiovascular events after noncardiac surgery: a pilot of the POISE-3 randomized controlled trial. Pilot Feasibility Stud 6: 104. doi:10.1186/s40814-020-00643-9
6. Tsan SEH, Viknaswaran NL, Cheong CC et al (2023) Prophylactic intravenous tranexamic acid and thromboembolism in non-cardiac surgery: a systematic review, meta-analysis and trial sequential analysis. Anaesthesia 78(9): 1153-1161. doi:10.1111/anae.16058
7. Longstaff C, Kolev K. Basic mechanisms and regulation of fibrinolysis. J Thromb Haemost. Jun 2015;13 Suppl 1:S98-105. doi:10.1111/jth.12935
8. Saes JL, Schols SEM, van Heerde WL, Nijziel MR (2018) Hemorrhagic disorders of fibrinolysis: a clinical review. J Thromb Haemost. May 30 2018;doi:10.1111/jth.14160
9. Patel PA, Wyrobek JA, Butwick AJ et al (2022) Update on Applications and Limitations of Perioperative Tranexamic Acid. Anesth Analg 135(3): 460-473. doi:10.1213/ane.0000000000006039
10. Picetti R, Shakur-Still H, Medcalf RL, Standing JF, Roberts I (2019) What concentration of tranexamic acid is needed to inhibit fibrinolysis? A systematic review of pharmacodynamics studies. Blood Coagul Fibrinolysis 30(1): 1-10. doi:10.1097/mbc.0000000000000789
11. Kim DJ, Cho SY, Jung KT (2024) Tranexamic acid - a promising hemostatic agent with limitations: A narrative review. Korean J Anesthesiol 77(4): 411-422. doi:10.4097/kja.23530
12. Devereaux PJ, Marcucci M, Painter TW et al (2022) Tranexamic Acid in Patients Undergoing Noncardiac Surgery. N Engl J Med 386(21): 1986-1997. doi:10.1056/NEJMoa2201171
13. Murao S, Nakata H, Roberts I, Yamakawa K (2021) Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis. Crit Care 25(1): 380. doi:10.1186/s13054-021-03799-9
14. Sentilhes L, Sénat MV, Le Lous M et al (2021) Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery. N Engl J Med 384(17): 1623-1634. doi:10.1056/NEJMoa2028788
15. Cheema HA, Ahmad AB, Ehsan M et al (2023) Tranexamic acid for the prevention of blood loss after cesarean section: an updated systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol MFM 5(8): 101049. doi:10.1016/j.ajogmf.2023.101049
16. Bellos I, Pergialiotis V (2022) Tranexamic acid for the prevention of postpartum hemorrhage in women undergoing cesarean delivery: An updated meta-analysis. Am J Obstet Gynecol 226(4): 510-523.e22. doi:10.1016/j.ajog.2021.09.025
17. Ker K, Sentilhes L, Shakur-Still H et al (2024) Tranexamic acid for postpartum bleeding: a systematic review and individual patient data meta-analysis of randomised controlled trials. Lancet 404(10463): 1657-1667. doi:10.1016/s0140-6736(24)02102-0
18. Vogel JP, Oladapo OT, Dowswell T, Gülmezoglu AM (2018) Updated WHO recommendation on intravenous tranexamic acid for the treatment of post-partum haemorrhage. Lancet Glob Health. 6(1): 18-19. doi:10.1016/s2214-109x(17)30428-x
19. Adepoju VA, Adnani QES, Adeniyi MO (2025) Tranexamic Acid for Postpartum Haemorrhage in Low-, Middle-, and High-Income Countries: An Integrative Review Aligned with the WHO PPH Roadmap (2023–2030). Womenn 5(1): 10.
20. Gungorduk K, Yıldırım G, Asıcıoğlu O, Gungorduk OC, Sudolmus S, Ark C (2011) Efficacy of intravenous tranexamic acid in reducing blood loss after elective cesarean section: a prospective, randomized, double-blind, placebo-controlled study. Am J Perinatol 28(3): 233-240. doi:10.1055/s-0030-1268238
21. Zhang S, Xiao C, Yu W et al (2022) Tranexamic acid safely reduces hidden blood loss in patients undergoing intertrochanteric fracture surgery: a randomized controlled trial. Eur J Trauma Emerg Surg 48(2): 731-741. doi:10.1007/s00068-020-01387-0
22. Stowers MDJ, Aoina J, Vane A, Poutawera V, Hill AG, Munro JT (2017) Tranexamic Acid in Knee Surgery Study-A Multicentered, Randomized, Controlled Trial. J Arthroplasty. Nov 2017;32(11):3379-3384. doi:10.1016/j.arth.2017.05.058
23. Rebai L, Mahfoudhi N, Fitouhi N, Daghmouri MA, Bahri K (2021) Intraoperative tranexamic acid use in patients undergoing excision of intracranial meningioma: Randomized, placebo-controlled trial. Surg Neurol Int 12: 289. doi:10.25259/sni_177_2021
24. Colomina MJ, Koo M, Basora M, Pizones J, Mora L, Bagó J (2017) Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial†. Br J Anaesth 118(3): 380-390. doi:10.1093/bja/aew434
25. Karanicolas PJ, Lin Y, McCluskey SA et al (2024) Tranexamic Acid in patients undergoing liver resection: the helix randomized clinical trial. Jama 332(13): 1080-1089. doi:10.1001/jama.2024.11783
26. Vanderbruggen W, Brits T, Tilborghs S, Derickx K, De Wachter S (2023) The effect of tranexamic acid on perioperative blood loss in transurethral resection of the prostate: A double-blind, randomized controlled trial. Prostate 83(16): 1584-1590. doi:10.1002/pros.24616
27. Dell'Amore A, Caroli G, Nizar A et al (2012) Can topical application of tranexamic acid reduce blood loss in thoracic surgery? A prospective randomised double blind investigation. Heart Lung Circ. Nov 2012;21(11):706-10. doi:10.1016/j.hlc.2012.06.016
28. Hu Y, Ge H, Yan H (2006) Using tranexamic acid in patients undergoing thoracotomy. Sichuan Medical Journal. 2006;(02):162-164.
29. Fillingham YA, Ramkumar DB, Jevsevar DS et al (2018) The Efficacy of Tranexamic Acid in Total Knee Arthroplasty: A Network Meta-Analysis. J Arthroplasty 33(10): 3090-3098. doi: 10.1016/j.arth.2018.04.043
30. Fillingham YA, Ramkumar DB, Jevsevar DS et al (2018) The Efficacy of Tranexamic Acid in Total Hip Arthroplasty: A Network Meta-analysis. J Arthroplasty 33(10): 3083-3089. doi:10.1016/j.arth.2018.06.023
31. Rainey JP, Fillingham YA, Hannon CP (2025) Tranexamic Acid is Safe and Effective in Reducing Blood Loss and Transfusion Rates in Nearly all Patients Undergoing Total Hip and Knee Arthroplasty. Arthroplasty Today: 101868. doi:https://doi.org/10.1016/j.artd.2025.101868
32. Gianakos AL, Hurley ET, Haring RS, Yoon RS, Liporace FA (2018) Reduction of Blood Loss by Tranexamic Acid Following Total Hip and Knee Arthroplasty: A Meta-Analysis. JBJS Rev 6(5): 1. doi:10.2106/jbjs.Rvw.17.00103
33. Porter SB, White LJ, Osagiede O, Robards CB, Spaulding AC (2020) Tranexamic Acid Administration Is Not Associated With an Increase in Complications in High-Risk Patients Undergoing Primary Total Knee or Total Hip Arthroplasty: A Retrospective Case-Control Study of 38,220 Patients. J Arthroplasty 35(1): 45-51. doi:10.1016/j.arth.2019.08.015
34. Ravi GK, Panda N, Ahluwalia J, Chauhan R, Singla N, Mahajan S (2021) Effect of tranexamic acid on blood loss, coagulation profile, and quality of surgical field in intracranial meningioma resection: A prospective randomized, double-blind, placebo-controlled study. Surg Neurol Int 12: 272. doi:10.25259/sni_296_2021
35. Khan MF, Patel S, Gensler R et al (2025) Neuro-oncologic applications of tranexamic acid: Systematic review and meta-analysis. J Clin Neurosci 140: 111541. doi:10.1016/j.jocn.2025.111541
36. Zhao Y, Xi C, Xu W, Yan J (2021) Role of tranexamic acid in blood loss control and blood transfusion management of patients undergoing multilevel spine surgery: A meta-analysis. Medicine (Baltimore) 100(7): 24678. doi:10.1097/md.0000000000024678
37. Yamanouchi K, Funao H, Fujita N, Ebata S, Yagi M (2024) Safety and Efficacy of Tranexamic Acid in Spinal Surgery: A Systematic Review and Meta-Analysis. Spine Surg Relat Res 8(3): 253-266. doi:10.22603/ssrr.2023-0244
38. de Carvalho Barros L, Avancini C, Gonçalves PE, Paiva WS, Gurgel RQ, Oliveira AMP (2025) Efficacy, safety and dose patterns of tranexamic acid in meningioma surgery: a systematic review and updated meta-analysis of randomized controlled trials. Neurosurg Rev 48(1): 23. doi:10.1007/s10143-025-03180-2
39. Vychopen M, Arlt F, Güresir E, Wach J (2024) Intraoperative tranexamic acid administration in cranial meningioma surgery: A meta-analysis of prospective randomized, double-blinded, and placebo-controlled trials. Front Oncol 14:1464671. doi:10.3389/fonc.2024.1464671
40. Lecker I, Wang DS, Romaschin AD, Peterson M, Mazer CD, Orser BA (2012) Tranexamic acid concentrations associated with human seizures inhibit glycine receptors. J Clin Invest 122(12): 4654-66. doi:10.1172/jci63375
41. Furtmüller R, Schlag MG, Berger M et al (2002) Tranexamic acid, a widely used antifibrinolytic agent, causes convulsions by a gamma-aminobutyric acid(A) receptor antagonistic effect. J Pharmacol Exp Ther 301(1): 168-173. doi: 10.1124/jpet.301.1.168
42. Koh A, Adiamah A, Gomez D, Sanyal S (2021) Safety and efficacy of tranexamic acid in minimizing perioperative bleeding in extrahepatic abdominal surgery: meta-analysis. BJS Open 5(2). doi:10.1093/bjsopen/zrab004
43. Hashmi TM, Burhan M, Naseem S et al (2025) Tranexamic acid in patients undergoing hepatic surgery: A systematic review and meta-analysis. Current Problems in Surgery 64:101717. doi:https://doi.org/10.1016/j.cpsurg.2025.101717
44. Tanashat M, Khalefa BB, Manasrah A et al (2025) Tranexamic Acid in Patients Undergoing Liver Resection: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin Appl Thromb Hemost. 31:10760296251342467. doi:10.1177/10760296251342467
45. Gao B, Liu Y, Yao YT (2024) Efficacy and safety of tranexamic acid in patients undergoing thoracic surgery: A systematic review and PRISMA-compliant meta-analysis. J Cardiothorac Surg 19(1): 195. doi:10.1186/s13019-024-02716-9
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2. Tian L, Li X, He L, Ji H, Yao Y (2024) Hemostatic effects of tranexamic acid in cardiac surgical patients with antiplatelet therapy: A systematic review and meta-analysis. Perioper Med (Lond) 13(1):58. doi:10.1186/s13741-024-00418-3
3. Roberts I, Murphy MF, Moonesinghe R et al (2024) Wider use of tranexamic acid to reduce surgical bleeding could benefit patients and health systems. Bmj 385: 079444. doi:10.1136/bmj-2024-079444
4. Ockerman A, Vanassche T, Garip M et al (2021) Tranexamic acid for the prevention and treatment of bleeding in surgery, trauma and bleeding disorders: A narrative review. Thromb J 19(1): 54. doi:10.1186/s12959-021-00303-9
5. Marcucci M, Duceppe E, Le Manach Y et al (2020) Tranexamic acid and rosuvastatin in patients at risk of cardiovascular events after noncardiac surgery: a pilot of the POISE-3 randomized controlled trial. Pilot Feasibility Stud 6: 104. doi:10.1186/s40814-020-00643-9
6. Tsan SEH, Viknaswaran NL, Cheong CC et al (2023) Prophylactic intravenous tranexamic acid and thromboembolism in non-cardiac surgery: a systematic review, meta-analysis and trial sequential analysis. Anaesthesia 78(9): 1153-1161. doi:10.1111/anae.16058
7. Longstaff C, Kolev K. Basic mechanisms and regulation of fibrinolysis. J Thromb Haemost. Jun 2015;13 Suppl 1:S98-105. doi:10.1111/jth.12935
8. Saes JL, Schols SEM, van Heerde WL, Nijziel MR (2018) Hemorrhagic disorders of fibrinolysis: a clinical review. J Thromb Haemost. May 30 2018;doi:10.1111/jth.14160
9. Patel PA, Wyrobek JA, Butwick AJ et al (2022) Update on Applications and Limitations of Perioperative Tranexamic Acid. Anesth Analg 135(3): 460-473. doi:10.1213/ane.0000000000006039
10. Picetti R, Shakur-Still H, Medcalf RL, Standing JF, Roberts I (2019) What concentration of tranexamic acid is needed to inhibit fibrinolysis? A systematic review of pharmacodynamics studies. Blood Coagul Fibrinolysis 30(1): 1-10. doi:10.1097/mbc.0000000000000789
11. Kim DJ, Cho SY, Jung KT (2024) Tranexamic acid - a promising hemostatic agent with limitations: A narrative review. Korean J Anesthesiol 77(4): 411-422. doi:10.4097/kja.23530
12. Devereaux PJ, Marcucci M, Painter TW et al (2022) Tranexamic Acid in Patients Undergoing Noncardiac Surgery. N Engl J Med 386(21): 1986-1997. doi:10.1056/NEJMoa2201171
13. Murao S, Nakata H, Roberts I, Yamakawa K (2021) Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis. Crit Care 25(1): 380. doi:10.1186/s13054-021-03799-9
14. Sentilhes L, Sénat MV, Le Lous M et al (2021) Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery. N Engl J Med 384(17): 1623-1634. doi:10.1056/NEJMoa2028788
15. Cheema HA, Ahmad AB, Ehsan M et al (2023) Tranexamic acid for the prevention of blood loss after cesarean section: an updated systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol MFM 5(8): 101049. doi:10.1016/j.ajogmf.2023.101049
16. Bellos I, Pergialiotis V (2022) Tranexamic acid for the prevention of postpartum hemorrhage in women undergoing cesarean delivery: An updated meta-analysis. Am J Obstet Gynecol 226(4): 510-523.e22. doi:10.1016/j.ajog.2021.09.025
17. Ker K, Sentilhes L, Shakur-Still H et al (2024) Tranexamic acid for postpartum bleeding: a systematic review and individual patient data meta-analysis of randomised controlled trials. Lancet 404(10463): 1657-1667. doi:10.1016/s0140-6736(24)02102-0
18. Vogel JP, Oladapo OT, Dowswell T, Gülmezoglu AM (2018) Updated WHO recommendation on intravenous tranexamic acid for the treatment of post-partum haemorrhage. Lancet Glob Health. 6(1): 18-19. doi:10.1016/s2214-109x(17)30428-x
19. Adepoju VA, Adnani QES, Adeniyi MO (2025) Tranexamic Acid for Postpartum Haemorrhage in Low-, Middle-, and High-Income Countries: An Integrative Review Aligned with the WHO PPH Roadmap (2023–2030). Womenn 5(1): 10.
20. Gungorduk K, Yıldırım G, Asıcıoğlu O, Gungorduk OC, Sudolmus S, Ark C (2011) Efficacy of intravenous tranexamic acid in reducing blood loss after elective cesarean section: a prospective, randomized, double-blind, placebo-controlled study. Am J Perinatol 28(3): 233-240. doi:10.1055/s-0030-1268238
21. Zhang S, Xiao C, Yu W et al (2022) Tranexamic acid safely reduces hidden blood loss in patients undergoing intertrochanteric fracture surgery: a randomized controlled trial. Eur J Trauma Emerg Surg 48(2): 731-741. doi:10.1007/s00068-020-01387-0
22. Stowers MDJ, Aoina J, Vane A, Poutawera V, Hill AG, Munro JT (2017) Tranexamic Acid in Knee Surgery Study-A Multicentered, Randomized, Controlled Trial. J Arthroplasty. Nov 2017;32(11):3379-3384. doi:10.1016/j.arth.2017.05.058
23. Rebai L, Mahfoudhi N, Fitouhi N, Daghmouri MA, Bahri K (2021) Intraoperative tranexamic acid use in patients undergoing excision of intracranial meningioma: Randomized, placebo-controlled trial. Surg Neurol Int 12: 289. doi:10.25259/sni_177_2021
24. Colomina MJ, Koo M, Basora M, Pizones J, Mora L, Bagó J (2017) Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial†. Br J Anaesth 118(3): 380-390. doi:10.1093/bja/aew434
25. Karanicolas PJ, Lin Y, McCluskey SA et al (2024) Tranexamic Acid in patients undergoing liver resection: the helix randomized clinical trial. Jama 332(13): 1080-1089. doi:10.1001/jama.2024.11783
26. Vanderbruggen W, Brits T, Tilborghs S, Derickx K, De Wachter S (2023) The effect of tranexamic acid on perioperative blood loss in transurethral resection of the prostate: A double-blind, randomized controlled trial. Prostate 83(16): 1584-1590. doi:10.1002/pros.24616
27. Dell'Amore A, Caroli G, Nizar A et al (2012) Can topical application of tranexamic acid reduce blood loss in thoracic surgery? A prospective randomised double blind investigation. Heart Lung Circ. Nov 2012;21(11):706-10. doi:10.1016/j.hlc.2012.06.016
28. Hu Y, Ge H, Yan H (2006) Using tranexamic acid in patients undergoing thoracotomy. Sichuan Medical Journal. 2006;(02):162-164.
29. Fillingham YA, Ramkumar DB, Jevsevar DS et al (2018) The Efficacy of Tranexamic Acid in Total Knee Arthroplasty: A Network Meta-Analysis. J Arthroplasty 33(10): 3090-3098. doi: 10.1016/j.arth.2018.04.043
30. Fillingham YA, Ramkumar DB, Jevsevar DS et al (2018) The Efficacy of Tranexamic Acid in Total Hip Arthroplasty: A Network Meta-analysis. J Arthroplasty 33(10): 3083-3089. doi:10.1016/j.arth.2018.06.023
31. Rainey JP, Fillingham YA, Hannon CP (2025) Tranexamic Acid is Safe and Effective in Reducing Blood Loss and Transfusion Rates in Nearly all Patients Undergoing Total Hip and Knee Arthroplasty. Arthroplasty Today: 101868. doi:https://doi.org/10.1016/j.artd.2025.101868
32. Gianakos AL, Hurley ET, Haring RS, Yoon RS, Liporace FA (2018) Reduction of Blood Loss by Tranexamic Acid Following Total Hip and Knee Arthroplasty: A Meta-Analysis. JBJS Rev 6(5): 1. doi:10.2106/jbjs.Rvw.17.00103
33. Porter SB, White LJ, Osagiede O, Robards CB, Spaulding AC (2020) Tranexamic Acid Administration Is Not Associated With an Increase in Complications in High-Risk Patients Undergoing Primary Total Knee or Total Hip Arthroplasty: A Retrospective Case-Control Study of 38,220 Patients. J Arthroplasty 35(1): 45-51. doi:10.1016/j.arth.2019.08.015
34. Ravi GK, Panda N, Ahluwalia J, Chauhan R, Singla N, Mahajan S (2021) Effect of tranexamic acid on blood loss, coagulation profile, and quality of surgical field in intracranial meningioma resection: A prospective randomized, double-blind, placebo-controlled study. Surg Neurol Int 12: 272. doi:10.25259/sni_296_2021
35. Khan MF, Patel S, Gensler R et al (2025) Neuro-oncologic applications of tranexamic acid: Systematic review and meta-analysis. J Clin Neurosci 140: 111541. doi:10.1016/j.jocn.2025.111541
36. Zhao Y, Xi C, Xu W, Yan J (2021) Role of tranexamic acid in blood loss control and blood transfusion management of patients undergoing multilevel spine surgery: A meta-analysis. Medicine (Baltimore) 100(7): 24678. doi:10.1097/md.0000000000024678
37. Yamanouchi K, Funao H, Fujita N, Ebata S, Yagi M (2024) Safety and Efficacy of Tranexamic Acid in Spinal Surgery: A Systematic Review and Meta-Analysis. Spine Surg Relat Res 8(3): 253-266. doi:10.22603/ssrr.2023-0244
38. de Carvalho Barros L, Avancini C, Gonçalves PE, Paiva WS, Gurgel RQ, Oliveira AMP (2025) Efficacy, safety and dose patterns of tranexamic acid in meningioma surgery: a systematic review and updated meta-analysis of randomized controlled trials. Neurosurg Rev 48(1): 23. doi:10.1007/s10143-025-03180-2
39. Vychopen M, Arlt F, Güresir E, Wach J (2024) Intraoperative tranexamic acid administration in cranial meningioma surgery: A meta-analysis of prospective randomized, double-blinded, and placebo-controlled trials. Front Oncol 14:1464671. doi:10.3389/fonc.2024.1464671
40. Lecker I, Wang DS, Romaschin AD, Peterson M, Mazer CD, Orser BA (2012) Tranexamic acid concentrations associated with human seizures inhibit glycine receptors. J Clin Invest 122(12): 4654-66. doi:10.1172/jci63375
41. Furtmüller R, Schlag MG, Berger M et al (2002) Tranexamic acid, a widely used antifibrinolytic agent, causes convulsions by a gamma-aminobutyric acid(A) receptor antagonistic effect. J Pharmacol Exp Ther 301(1): 168-173. doi: 10.1124/jpet.301.1.168
42. Koh A, Adiamah A, Gomez D, Sanyal S (2021) Safety and efficacy of tranexamic acid in minimizing perioperative bleeding in extrahepatic abdominal surgery: meta-analysis. BJS Open 5(2). doi:10.1093/bjsopen/zrab004
43. Hashmi TM, Burhan M, Naseem S et al (2025) Tranexamic acid in patients undergoing hepatic surgery: A systematic review and meta-analysis. Current Problems in Surgery 64:101717. doi:https://doi.org/10.1016/j.cpsurg.2025.101717
44. Tanashat M, Khalefa BB, Manasrah A et al (2025) Tranexamic Acid in Patients Undergoing Liver Resection: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin Appl Thromb Hemost. 31:10760296251342467. doi:10.1177/10760296251342467
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LâmV. T., & HàH. T. (2026). Vai trò, nguy cơ và ứng dụng lâm sàng hiện nay của axit tranexamic trong phẫu thuật ngoài tim. Journal of 108 - Clinical Medicine and Phamarcy, 21(5). https://doi.org/10.52389/ydls.v21i5.3063