What is the role of antifibrinolytic agents in the treatment of disseminated intravascular coagulation (DIC)?

Updated: Dec 06, 2020
  • Author: Marcel M Levi, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

In general, antifibrinolytic agents (eg, tranexamic acid, ε-aminocaproic acid) should be avoided in DIC because they are known to produce thrombotic complications, such as myocardial infarction and renal artery thrombosis when there is systemic clotting. However, in patients with trauma and massive blood loss, tranexamic acid has been shown to be effective in reducing blood loss and improving survival. [71]  Similarly, in massive postpartum hemorrhage, high-dose tranexamic acid has been shown to be effective. [72]  Antifibrinolytics also may be useful in cases of DIC secondary to hyperfibrinolysis associated with acute promyelocytic leukemia and other forms of cancer when alpha-2-antiplasmin is uniquely decreased. These agents should always be administered with heparin to arrest their prothrombotic effects. [17]


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