Clinical Outcomes and Safety Profile of Tranexamic Acid Use in Critically Ill Patients with Bleeding: A Single-Center...

Background: Tranexamic acid (TXA) is an antifibrinolytic agent that helps prevent and manage bleeding events. In patients with trauma, TXA reduced bleeding-related deaths by one-third. Moreover, TXA showed a lower risk of mortality from bleeding in postpartum patients. Few studies have examined the appropriateness of TXA use for the management of bleeding in critically ill patients. This study aimed to describe the clinical outcomes and the safety of TXA use in critically ill patients with bleeding. Methods: This single-center, single-arm descriptive study was conducted at King Faisal Specialist Hospital & Research Center, Jeddah, between January 2018 and March 2023. The study included adult patients 18 years or older who were admitted to the medical intensive care unit (ICU) for ≥48 h and had documented bleeding that was treated with TXA for at least one dose. The primary outcome was the frequency of thrombotic events. Secondary outcomes included time from bleeding onset to bleeding resolution, rebleeding event at 30 days, time from bleeding onset to rebleeding event, ICU and hospital length of stay, and 30-day all-cause mortality. Results: A total of 129 patients were included in the study, 55% of whom were male. The median age was 60.9 years. The median APACHE II score was 22 (15-29). At baseline, 24.8% of patients had a history of bleeding. Major bleeding occurred in 86.1% of the patients. The frequency of thrombotic events was 2.3%. The median bleeding duration was 3.9 days (1.9-7.0). Rebleeding events at 30 days occurred in 24.8% of patients, with a median time of 11.7 days (8-14.8) from bleeding onset to rebleeding. The average ICU length was 12 days (6-24), and the average hospital length of stay was 25 days (15-50). The 30-day all-cause mortality rate was 55.8%. Multivariable analysis assessing factors contributing to mortality revealed that higher APACHE II score was strongly associated with increased mortality (adjusted OR 1.14 per point increase, 95% CI 1.07-1.21, p < 0.001), while higher platelet counts were independently protective, with each 10 × 10⁹/L increase associated with a 4% reduction in mortality odds (adjusted OR 0.96, 95% CI 0.93-0.99, p = 0.034). Conclusions: In this descriptive study, TXA use in critically ill patients was accompanied by low absolute rates of thrombotic and rebleeding events. Further studies with larger sample sizes and comparable groups are needed to examine the appropriateness of TXA use in managing bleeding events in the ICU.