Thromboelastometric assessment of the haemostatic effect of tranexamic acid as an adjunct to prophylactic platelet transfusions in patients with haematological malignancies undergoing intensive chemotherapy: A pilot study

Background and Objectives Tranexamic acid (TXA) as an adjunct to prophylactic platelet transfusion is sometimes used to prevent bleeding in patients with malignancies experiencing chemotherapy‐induced thrombocytopenia. However, there is little biological evidence in support. This pilot exploratory study aimed to evaluate the haemostatic efficacy of TXA before and after platelet transfusion versus platelet transfusion alone in patients with haematological malignancies experiencing chemotherapy‐induced thrombocytopenia. Materials and Methods Rotational thromboelastometry (ROTEM; EXTEM, tissue plasminogen activator [tPA]‐EXTEM and FIBTEM) was used to assess the haemostatic effect of these treatments. Results Eighteen patients were randomized to receive platelet transfusion and either 3 or 1.5 g of TXA per day or to be observed. At enrolment, ROTEM parameters were similar across groups. TXA alone did not affect EXTEM clot formation time (CFT) or maximum clot firmness (MCF). A trend towards increased EXTEM CFT and MCF values 2 h after platelet transfusion was observed. The effect of TXA was witnessed by the increase in tPA‐EXTEM lysis index at 60 min (LI60). In the observation group, tPA‐EXTEM LI60 also significantly increased after platelet transfusion. The World Health Organization (WHO) rates for grade ≥2 bleeding and the median number of platelet transfusions were similar across all groups. Conclusion Platelet transfusion as well as TXA decreased fibrinolysis for this patient population. This could be explained by the plasminogen activator inhibitor 1 contained in platelets. Future research should explore other alternative treatments and the utility of viscoelastometric testing to guide platelet transfusions, particularly in cases of bleeding or platelet transfusion refractoriness.