2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/2iy5wruuedsh6.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/00yc7rcvua6a7.js","/_next/static/immutable/chunks/37ktb71aq3480.js","/_next/static/immutable/chunks/2d50b-7eu4558.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/2d6noqpp6ehas.js","/_next/static/immutable/chunks/1sx186c93bpzg.js","/_next/static/immutable/chunks/3dc-1n866s65i.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2w1bvggzb0ga8.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T96f,Tranexamic acid (TXA) is increasingly used to minimize perioperative bleeding. However, its efficacy and safety profile across general surgical procedures remains unclear. To evaluate the efficacy and safety of prophylactic TXA in reducing intraoperative blood loss, need for transfusion, and major bleeding in general surgery, while assessing its association with thromboembolic events and mortality. PubMed, Embase, and Cochrane Library were systematically searched from inception to April 3, 2025. Randomized clinical trials (RCTs) comparing TXA to placebo in adult patients undergoing general surgery and reporting at least 1 predefined outcome of interest were included. Two reviewers independently extracted data and assessed risk of bias. Mean differences (MDs) and risk ratios (RRs) with 95% CIs were pooled using random-effects models. Heterogeneity was assessed using the I2 statistic. Twenty-six RCTs with a total of 6976 patients were included. TXA use was associated with lower intraoperative blood loss (MD, -35.85 mL; 95% CI, -57.20 to -14.51 mL; I2 = 91%; P = .001), reduced need for transfusion (RR, 0.75; 95% CI, 0.60-0.94; I2 = 54%; P = .01), and fewer major bleeding events (RR, 0.72; 95% CI, 0.59-0.89; I2 = 0%; P = .002). No significant differences were found in venous thromboembolism (RR, 1.09; 95% CI, 0.62-1.92; I2 = 15%; P = .75), mortality (RR, 1.08; 95% CI, 0.72-1.61; I2 = 0%; P = .71), and length of stay (MD, -0.54 days; 95% CI, -1.15 to 0.06 days; I2 = 73%; P = .08). In the subgroup analysis restricted to abdominal procedures, the benefits observed in the overall population on intraoperative blood loss and need for transfusion were no longer present. In the hepatobiliary subgroup, TXA was associated with a significant reduction in major bleeding (RR, 0.59; 95% CI, 0.39-0.90; I2 = 0%; P = .01), while no significant differences were observed for the other outcomes. This systematic review and meta-analysis found that prophylactic TXA use was associated with lower intraoperative blood loss, transfusion requirements, and major bleeding without an observed increase in thromboembolic or mortality risk. Although these findings support the use of TXA in general surgery procedures, the decision to use TXA should be individualized considering individual patient characteristics and the specific procedure being performed.31:T14f3, Importance Tranexamic acid (TXA) is increasingly used to minimize perioperative bleeding. However, its efficacy and safety profile across general surgical procedures remains unclear. Objective To evaluate the efficacy and safety of prophylactic TXA in reducing intraoperative blood loss, need for transfusion, and major bleeding in general surgery, while assessing its association with thromboembolic events and mortality. Data Sources PubMed, Embase, and Cochrane Library were systematically searched from inception to April 3, 2025. Study Selection Randomized clinical trials (RCTs) comparing TXA to placebo in adult patients undergoing general surgery and reporting at least 1 predefined outcome of interest were included. Data Extraction and Synthesis Two reviewers independently extracted data and assessed risk of bias. Mean differences (MDs) and risk ratios (RRs) with 95% CIs were pooled using random-effects models. Heterogeneity was assessed using the I 2 statistic. Results Twenty-six RCTs with a total of 6976 patients were included. TXA use was associated with lower intraoperative blood loss (MD, −35.85 mL; 95% CI, −57.20 to −14.51 mL; I 2 = 91%; P = .001), reduced need for transfusion (RR, 0.75; 95% CI, 0.60-0.94; I 2 = 54%; P = .01), and fewer major bleeding events (RR, 0.72; 95% CI, 0.59-0.89; I 2 = 0%; P = .002). No significant differences were found in venous thromboembolism (RR, 1.09; 95% CI, 0.62-1.92; I 2 = 15%; P = .75), mortality (RR, 1.08; 95% CI, 0.72-1.61; I 2 = 0%; P = .71), and length of stay (MD, −0.54 days; 95% CI, −1.15 to 0.06 days; I 2 = 73%; P = .08). In the subgroup analysis restricted to abdominal procedures, the benefits observed in the overall population on intraoperative blood loss and need for transfusion were no longer present. In the hepatobiliary subgroup, TXA was associated with a significant reduction in major bleeding (RR, 0.59; 95% CI, 0.39-0.90; I 2 = 0%; P = .01), while no significant differences were observed for the other outcomes. Conclusions and Relevance This systematic review and meta-analysis found that prophylactic TXA use was associated with lower intraoperative blood loss, transfusion requirements, and major bleeding without an observed increase in thromboembolic or mortality risk. Although these findings support the use of TXA in general surgery procedures, the decision to use TXA should be individualized considering individual patient characteristics and the specific procedure being performed. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"tranexamic acid: generic Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on tranexamic acid (generic). Clinician-written summaries and actionable practice insights. 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The most common gaps were appropriate blood product selection (42.3%), appropriate ratios (38.5%), and appropriate additional products (38.5%). All five services lacking an MHP stocked red cells only (p=0.012).","limitations":"- No patient-level outcome data collected, so clinical impact of MHP gaps is unknown.\n- Results are limited to Victoria and may not generalise to other Australian states or countries.\n- Survey responses may not reflect actual clinical practice, as clinician judgement also shapes care.","practice_takeaway":"Rural and regional centres managing critical bleeding — especially those with red cells only — should undergo individualised MHP review to close compliance gaps in blood product selection, ratios, and adjuncts like tranexamic acid. Targeted online education on MHP creation, focused on these specific domains, is recommended."}},{"doi":"10.1001/jamadermatol.2026.0413","pmid":"42418191","title":"Melasma","journal_title":"JAMA Dermatology","journal_issn":"2168-6068","published_at":"2026-07-08T00:00:00.000Z","url":"https://doi.org/10.1001/jamadermatol.2026.0413","source_score":3,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-13T17:42:28.088Z","updated_at":"2026-07-13T17:42:28.088Z","tags":[{"paper_doi":"10.1001/jamadermatol.2026.0413","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.0413","tag_type":"category","value":"Dermatology","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.0413","tag_type":"condition","value":"Melasma","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.0413","tag_type":"generic","value":"tranexamic acid","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.0413","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.0413","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.0413","tag_type":"modality","value":"Chemical Peel","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.0413","tag_type":"modality","value":"Laser Therapy","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.0413","tag_type":"modality","value":"Microneedling","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.0413","tag_type":"modality","value":"Topical Depigmenting Agent","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.0413","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.0413","tag_type":"study_design","value":"Patient Education / Review","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.0413","tag_type":"warning","value":"Level of evidence is assigned as 7 (expert opinion/patient education material) given the absence of study methodology or data.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.0413","tag_type":"warning","value":"Study design label 'Patient Education / Review' is used as no standard research design applies.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.0413","tag_type":"warning","value":"This is a JAMA Dermatology Patient Page (lay education article), not a primary research study or systematic review — no original data or statistical findings are reported.","value_numeric":null}],"summaries":{"what_studied":"This Patient Page covers the causes, symptoms, diagnosis, and treatment options for melasma, targeting a general and clinical audience.","key_result":"Melasma affects about 1 in 100 people, is most common in women of reproductive age, and is more prevalent in those of African, Asian, Hispanic, and Middle Eastern ancestry. Treatments (topical agents, oral tranexamic acid, procedures) can improve but not cure the condition, with improvement often taking several months.","limitations":"This is a patient education summary, not an original research study — no primary data, control groups, or outcome measures are reported.","practice_takeaway":"Counsel patients that daily broad-spectrum tinted sunscreen (SPF ≥30), topical lightening agents, and — for severe cases — oral tranexamic acid are the mainstays of management. Set clear expectations: melasma is chronic, improvement takes months, and procedures should be done by a board-certified dermatologist to minimize adverse effects."}},{"doi":"10.1182/blood.2025029780","pmid":"42275251","title":"Anti-fibrinolytic strategies improve liver regeneration in mice and reduce post-hepatectomy liver failure in patients","journal_title":"Blood Journal","journal_issn":"0006-4971","published_at":"2026-06-11T00:00:00.000Z","url":"https://doi.org/10.1182/blood.2025029780","source_score":39,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-27T13:27:53.271Z","updated_at":"2026-06-27T13:27:53.271Z","tags":[{"paper_doi":"10.1182/blood.2025029780","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1182/blood.2025029780","tag_type":"category","value":"Hematology","value_numeric":null},{"paper_doi":"10.1182/blood.2025029780","tag_type":"condition","value":"Liver Regeneration","value_numeric":null},{"paper_doi":"10.1182/blood.2025029780","tag_type":"condition","value":"Post-Hepatectomy Liver Failure","value_numeric":null},{"paper_doi":"10.1182/blood.2025029780","tag_type":"generic","value":"tranexamic acid","value_numeric":null},{"paper_doi":"10.1182/blood.2025029780","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1182/blood.2025029780","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1182/blood.2025029780","tag_type":"modality","value":"Anti-Fibrinolytic Agent","value_numeric":null},{"paper_doi":"10.1182/blood.2025029780","tag_type":"modality","value":"RNA Interference (siRNA)","value_numeric":null},{"paper_doi":"10.1182/blood.2025029780","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1182/blood.2025029780","tag_type":"study_design","value":"Translational Study (Animal + Randomized Controlled Trial)","value_numeric":null},{"paper_doi":"10.1182/blood.2025029780","tag_type":"warning","value":"Only the abstract was provided — specific numerical outcomes (odds ratios, confidence intervals, sample sizes) from the HeLiX trial are not available and could not be included.","value_numeric":null},{"paper_doi":"10.1182/blood.2025029780","tag_type":"warning","value":"The 'practice_changing' impact flag is tentative pending full publication review, as abstract-level data limits complete assessment of benefit-risk balance.","value_numeric":null},{"paper_doi":"10.1182/blood.2025029780","tag_type":"warning","value":"The study design tag reflects a combined translational (animal + RCT) design; the level of evidence (2) is based on the RCT component (HeLiX trial) only.","value_numeric":null}],"summaries":{"what_studied":"This study evaluated whether anti-fibrinolytic strategies (siRNA-induced plasminogen reduction in mice; tranexamic acid in patients via the HeLiX trial) could improve liver regeneration and reduce post-hepatectomy liver failure (PHLF) after partial hepatectomy.","key_result":"In mice, siRNA-induced plasminogen deficiency promoted hepatocyte proliferation after partial hepatectomy (unlike genetic deficiency models). In the HeLiX trial, tranexamic acid reduced the odds of post-hepatectomy liver failure in patients.","limitations":"Abstract only — specific effect sizes, confidence intervals, sample sizes, and full safety data are not available. The mechanistic contrast between siRNA-induced and genetic plasminogen deficiency models raises questions about compensatory developmental effects in genetic models. Translation from murine models to clinical practice requires further validation.","practice_takeaway":"Tranexamic acid — already widely available — may reduce post-hepatectomy liver failure risk and could be considered as a perioperative strategy in patients undergoing partial hepatectomy. Confirm full HeLiX trial data before routine adoption."}},{"doi":"10.1056/nejmoa2515820","pmid":"42267805","title":"Hospital Policy of Tranexamic Acid to Reduce Transfusion in Major Noncardiac Surgery","journal_title":"New England Journal of Medicine","journal_issn":"0028-4793","published_at":"2026-06-10T00:00:00.000Z","url":"https://doi.org/10.1056/nejmoa2515820","source_score":169,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-21T13:34:39.513Z","updated_at":"2026-07-21T13:34:39.513Z","tags":[{"paper_doi":"10.1056/nejmoa2515820","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1056/nejmoa2515820","tag_type":"category","value":"Medicine, General & Internal","value_numeric":null},{"paper_doi":"10.1056/nejmoa2515820","tag_type":"condition","value":"Surgical Blood Loss","value_numeric":null},{"paper_doi":"10.1056/nejmoa2515820","tag_type":"condition","value":"Venous Thromboembolism","value_numeric":null},{"paper_doi":"10.1056/nejmoa2515820","tag_type":"generic","value":"tranexamic acid","value_numeric":null},{"paper_doi":"10.1056/nejmoa2515820","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1056/nejmoa2515820","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1056/nejmoa2515820","tag_type":"modality","value":"Antifibrinolytic Agent","value_numeric":null},{"paper_doi":"10.1056/nejmoa2515820","tag_type":"sample_size","value":"n=8273","value_numeric":8273},{"paper_doi":"10.1056/nejmoa2515820","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1056/nejmoa2515820","tag_type":"study_design","value":"Cluster-Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1056/nejmoa2515820","tag_type":"warning","value":"Oncologic surgery was the dominant procedure type (60.5%), so subgroup effects in other surgical categories (e.g., orthopedic, vascular) are not separately reported here and may differ.","value_numeric":null},{"paper_doi":"10.1056/nejmoa2515820","tag_type":"warning","value":"The cluster-crossover design means individual patients were not randomized; hospital policy was the unit of randomization, which may introduce institutional confounding.","value_numeric":null},{"paper_doi":"10.1056/nejmoa2515820","tag_type":"warning","value":"The noninferiority margin for VTE (upper CI boundary of 1.46) is a clinician-defined threshold — some may consider this margin wide for a thrombotic outcome.","value_numeric":null}],"summaries":{"what_studied":"A multicenter, double-blind, cluster-randomized, placebo-controlled crossover trial (TRACTION) evaluated whether a hospital-wide policy of intraoperative tranexamic acid (vs. placebo) reduces red-cell transfusion and is safe regarding venous thromboembolism (VTE) in 8,273 high-risk patients undergoing major noncardiac surgery across 10 Canadian hospitals, with 90-day follow-up.","key_result":"Red-cell transfusion occurred in 7.4% (306/4,156) with tranexamic acid vs. 9.8% (403/4,117) with placebo (RR 0.73; 95% CI 0.61–0.86; adjusted difference −2.7 pp). VTE within 90 days was 2.1% in both groups (RR 0.96; 95% CI 0.65–1.38), meeting the prespecified noninferiority margin.","limitations":"- Study limited to 10 Canadian hospitals; generalizability to non-Canadian or lower-resource settings is uncertain.\n- Oncologic surgery comprised 60.5% of cases, so findings may not apply equally across all surgical subspecialties.\n- The cluster-crossover design introduces potential for carryover effects between policy periods.","practice_takeaway":"A hospital-wide policy of intraoperative tranexamic acid meaningfully cuts transfusion rates in major noncardiac surgery without increasing VTE risk. Institutions performing high-risk noncardiac surgery should consider adopting tranexamic acid as a default intraoperative protocol."}},{"doi":"10.1007/s40257-026-01044-z","pmid":"42234395","title":"Practical Therapeutic Strategies for Acne-Induced Hyperpigmentation Across all Skin Types","journal_title":"American Journal of Clinical Dermatology","journal_issn":"1175-0561","published_at":"2026-06-03T00:00:00.000Z","url":"https://doi.org/10.1007/s40257-026-01044-z","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-10T14:24:05.536Z","updated_at":"2026-06-10T14:24:05.536Z","tags":[{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"category","value":"Dermatology","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"condition","value":"Acne Vulgaris","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"condition","value":"Post-Inflammatory Erythema","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"condition","value":"Post-Inflammatory Hyperpigmentation","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"generic","value":"azelaic acid","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"generic","value":"hydroquinone","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"generic","value":"isotretinoin","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"generic","value":"tranexamic acid","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"modality","value":"Antifibrinolytic","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"modality","value":"Chemical Peel","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"modality","value":"Laser","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"modality","value":"Microneedling","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"modality","value":"Systemic Retinoid","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"modality","value":"Topical Depigmenting Agent","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"modality","value":"Topical Retinoid","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"warning","value":"Female sex is listed as a risk factor for AIH, but sex-stratified treatment outcome data are not presented; generalizability across sexes is unclear.","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"warning","value":"No sample size applies — this is a review article with no original patient cohort.","value_numeric":null},{"paper_doi":"10.1007/s40257-026-01044-z","tag_type":"warning","value":"This is a narrative review published in 2026; no systematic search strategy or PRISMA methodology is described, so recommendations reflect expert opinion rather than pooled evidence.","value_numeric":null}],"summaries":{"what_studied":"This review evaluates therapeutic strategies for acne-induced hyperpigmentation (AIH) and acne-induced macular erythema across all Fitzpatrick skin types, covering topical agents, systemic therapies, procedural options, and photoprotection.","key_result":"Up to 85% of patients with Fitzpatrick phototypes IV–VI develop post-inflammatory hyperpigmentation after inflammatory acne. Both AIH and macular erythema can persist months to years and may impair quality of life more than active acne itself. Treatment options include topical agents (azelaic acid, retinoids, hydroquinone, antioxidants), systemic therapies (isotretinoin, oral antibiotics, oral tranexamic acid), chemical peels, lasers, and microneedling.","limitations":"No validated patient-reported outcome measures specific to AIH or acne-induced macular erythema currently exist; the article is a narrative review without a systematic literature search or meta-analysis, limiting the strength of evidence-based recommendations.","practice_takeaway":"For patients with skin of color presenting with post-acne hyperpigmentation, prioritize strict photoprotection alongside targeted depigmenting agents (e.g., azelaic acid, retinoids, hydroquinone) and treat active acne aggressively to reduce new lesions. Oral tranexamic acid and energy-based devices are additional options, but skin phototype must guide procedural choices to minimize risk of further pigmentary change."}},{"doi":"10.1097/ta.0000000000004920","pmid":"41589743","title":"Prehospital tranexamic acid bolus improves outcomes in traumatic brain injury: A Bayesian reanalysis of the prehospital TXA for TBI trial","journal_title":"Journal of Trauma and Acute Care Surgery","journal_issn":"2163-0755","published_at":"2026-05-22T00:00:00.000Z","url":"https://doi.org/10.1097/ta.0000000000004920","source_score":8,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-09T13:50:22.837Z","updated_at":"2026-06-09T13:50:22.837Z","tags":[{"paper_doi":"10.1097/ta.0000000000004920","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1097/ta.0000000000004920","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1097/ta.0000000000004920","tag_type":"condition","value":"Traumatic Brain Injury","value_numeric":null},{"paper_doi":"10.1097/ta.0000000000004920","tag_type":"generic","value":"tranexamic acid","value_numeric":null},{"paper_doi":"10.1097/ta.0000000000004920","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1097/ta.0000000000004920","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1097/ta.0000000000004920","tag_type":"modality","value":"Antifibrinolytic","value_numeric":null},{"paper_doi":"10.1097/ta.0000000000004920","tag_type":"sample_size","value":"n=not reported in abstract","value_numeric":null},{"paper_doi":"10.1097/ta.0000000000004920","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1097/ta.0000000000004920","tag_type":"study_design","value":"Post Hoc Bayesian Reanalysis of Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1097/ta.0000000000004920","tag_type":"warning","value":"Sample size (total N) was not reported in the abstract or provided text; the sample_size tag has been omitted accordingly.","value_numeric":null},{"paper_doi":"10.1097/ta.0000000000004920","tag_type":"warning","value":"Study design label reflects the dual nature of the work (secondary analysis of an RCT using Bayesian methods); the journal-assigned evidence level of 'Therapeutic; Level III' is used directly.","value_numeric":null},{"paper_doi":"10.1097/ta.0000000000004920","tag_type":"warning","value":"The 'practice_changing' impact flag reflects the directional strength of the Bayesian probabilities but should be interpreted cautiously given the post hoc design.","value_numeric":null},{"paper_doi":"10.1097/ta.0000000000004920","tag_type":"warning","value":"This is a post hoc Bayesian reanalysis — not a prospectively designed Bayesian trial — so prior specification and model assumptions are unverifiable from the abstract alone.","value_numeric":null}],"summaries":{"what_studied":"Post hoc Bayesian reanalysis of the prehospital TXA for TBI RCT, comparing three arms in moderate-to-severe TBI patients: 2-g TXA bolus, 1-g bolus + 1-g infusion (standard), and placebo — evaluating 6-month functional neurologic outcomes and 28-day/6-month mortality.","key_result":"The 2-g bolus arm showed a 95.3% posterior probability of improved 6-month functional neurologic outcomes and a 95.3% probability of reduced 28-day mortality vs. placebo. The standard (1-g bolus + 1-g infusion) arm had <50% probability of benefit vs. placebo for all outcomes.","limitations":"Post hoc analysis of an existing RCT limits causal inference. Bayesian priors were not pre-specified prospectively, introducing potential for researcher degrees of freedom. Results are probabilistic, not confirmatory, and the trial may not have been powered for subgroup comparisons between bolus and standard arms.","practice_takeaway":"For prehospital management of moderate-to-severe TBI, a 2-g TXA bolus — rather than the split 1-g bolus + 1-g infusion regimen — appears to offer the greatest probability of neurologic and survival benefit. Clinicians may consider bolus dosing when TXA is used in this setting, pending prospective confirmation."}},{"doi":"10.1093/esj/aakag043","pmid":"42095754","title":"European Stroke Organisation (ESO), European Association of Neurosurgical Societies (EANS) and European Society for Minimally Invasive Neurological Therapy (ESMINT) guideline on aneurysmal subarachnoid haemorrhage","journal_title":"European Stroke Journal","journal_issn":"2396-9873","published_at":"2026-05-07T00:00:00.000Z","url":"https://doi.org/10.1093/esj/aakag043","source_score":22,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-15T13:23:12.077Z","updated_at":"2026-05-15T13:23:12.077Z","tags":[{"paper_doi":"10.1093/esj/aakag043","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"condition","value":"Aneurysmal Subarachnoid Haemorrhage","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"condition","value":"Cerebral Vasospasm","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"condition","value":"Delayed Cerebral Ischaemia","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"condition","value":"Hydrocephalus","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"generic","value":"clazosentan","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"generic","value":"labetalol","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"generic","value":"magnesium sulfate","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"generic","value":"nimodipine","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"generic","value":"simvastatin","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"generic","value":"tirilazad","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"generic","value":"tranexamic acid","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"modality","value":"Antifibrinolytic","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"modality","value":"Calcium Channel Blocker","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"modality","value":"Endothelin Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"modality","value":"Endovascular Coiling","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"modality","value":"Flow Diverter","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"modality","value":"Intrasaccular Device","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"modality","value":"Magnesium Sulphate","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"modality","value":"Neurosurgical Clipping","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"modality","value":"Statin","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"study_design","value":"Clinical Practice Guideline","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"warning","value":"ISAT-2 trial cited was prematurely terminated at 14% enrolment; conclusions on non-coil endovascular devices remain very uncertain.","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"warning","value":"No single sample size applies — this is a guideline synthesising multiple meta-analyses and RCTs, not a single primary study; sample_size tag omitted accordingly.","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"warning","value":"Several recommendations (timing, ICU type, centre volume, endovascular devices other than coils) are expert-consensus only, not evidence-based, and should be interpreted with caution.","value_numeric":null},{"paper_doi":"10.1093/esj/aakag043","tag_type":"warning","value":"The study_design label 'Clinical Practice Guideline' is used; individual PICO analyses include meta-analyses and RCTs of varying quality, most rated low or very low.","value_numeric":null}],"summaries":{"what_studied":"This ESO/EANS/ESMINT guideline used GRADE methodology to develop evidence-based recommendations and expert-consensus statements on the management of aneurysmal subarachnoid haemorrhage (aSAH), covering rebleeding prevention, aneurysm treatment modality, DCI prevention and treatment, neuroimaging, neuromonitoring, hydrocephalus, ICU setting, centre volume, and radiological follow-up.","key_result":"High-quality evidence supports: (1) oral nimodipine to reduce poor functional outcome (OR 0.56; 95% CI 0.40–0.76 for coiling vs clipping); (2) regular coiling over clipping in good-grade patients (WFNS I–III) with aneurysms suitable for both (OR for poor outcome 0.69; 95% CI 0.58–0.83; absolute risk reduction 7%); (3) no routine antifibrinolytics (no effect on poor outcome: OR 1.03; 95% CI 0.86–1.23 despite reduced rebleeding); and (4) no role for tirilazad, statins, magnesium sulphate, or endothelin receptor antagonists. Expert consensus suggests treating within 24 h, at centres handling ≥70 aSAH cases/year, by operators performing >30 aneurysm procedures/year.","limitations":"Most PICOs rely on low- or very-low-quality evidence or observational data only; key trials on timing, ICU type, and endovascular devices other than coils were underpowered or prematurely stopped (e.g., ISAT-2 enrolled only 14% of target); expert-consensus statements reflect working group opinion and should not be treated as evidence-based.","practice_takeaway":"Give oral nimodipine to all aSAH patients and prefer regular coiling over clipping when both options are feasible in good-grade patients. Avoid antifibrinolytics, tirilazad, statins, magnesium sulphate, and endothelin receptor antagonists; treat the aneurysm within 24 h at a high-volume centre (≥70 aSAH cases/year) by an operator doing >30 aneurysm cases/year."}},{"doi":"10.1016/j.eururo.2026.03.019","pmid":"42020258","title":"Safety and Efficacy of Tranexamic Acid in Urologic Surgery: Results from the International, Randomized, Placebo-Controlled POISE-3 Trial","journal_title":"European Urology","journal_issn":"0302-2838","published_at":"2026-04-21T00:00:00.000Z","url":"https://doi.org/10.1016/j.eururo.2026.03.019","source_score":29,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-07T22:49:51.658Z","updated_at":"2026-05-07T22:49:51.658Z","tags":[{"paper_doi":"10.1016/j.eururo.2026.03.019","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.019","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.019","tag_type":"condition","value":"Perioperative Bleeding","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.019","tag_type":"condition","value":"Urologic Surgery","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.019","tag_type":"generic","value":"tranexamic acid","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.019","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.019","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.019","tag_type":"modality","value":"Antifibrinolytic Agent","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.019","tag_type":"sample_size","value":"n=1124","value_numeric":1124},{"paper_doi":"10.1016/j.eururo.2026.03.019","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.019","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.019","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously given the subgroup-analysis design, but the finding fills a clear gap in urologic guidelines.","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.019","tag_type":"warning","value":"The primary composite bleeding endpoint did not reach statistical significance (HR 0.73, CI crosses 1.0); the significant result applies specifically to the major bleeding subcomponent.","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.03.019","tag_type":"warning","value":"This is a pre-specified subgroup analysis of the broader POISE-3 trial, not a standalone RCT — findings should be interpreted with that context in mind.","value_numeric":null}],"summaries":{"what_studied":"This pre-specified subgroup analysis of the POISE-3 international RCT evaluated TXA (1 g IV at surgery start and end) vs. placebo in 1,124 patients undergoing urologic surgery (laparoscopic/robotic, open, transurethral, or percutaneous) over a 30-day follow-up period.","key_result":"TXA reduced major bleeding (6.1% vs. 9.5%; HR 0.63, 95% CI 0.41–0.97) and showed a non-significant trend toward reduced composite bleeding (8.1% vs. 10.9%; HR 0.73, 95% CI 0.50–1.07). The composite thrombotic safety outcome was similar between arms (12.1% vs. 10.9%; HR 1.12, 95% CI 0.79–1.58), with no meaningful difference in MINS, stroke, or VTE.","limitations":"- This is a subgroup analysis; the composite bleeding reduction did not reach statistical significance.\n- Patient-important thrombotic events (stroke, VTE) were rare, limiting precision for those estimates.\n- No subgroup interactions were found by surgical approach, cancer status, or antithrombotic use, but individual subgroups may have been underpowered.","practice_takeaway":"TXA (1 g IV at start and end of surgery) significantly reduced major bleeding in urologic surgery without a clear increase in thrombotic risk — consider its use, particularly in higher-risk bleeding cases. Major urologic guidelines currently lack recommendations on TXA; this data supports updating that guidance."}},{"doi":"10.1182/bloodadvances.2025018818","pmid":"41637560","title":"Guideline on the emergency management of critical bleeding in patients with immune thrombocytopenia","journal_title":"Blood Advances","journal_issn":"2473-9529","published_at":"2026-02-04T00:00:00.000Z","url":"https://doi.org/10.1182/bloodadvances.2025018818","source_score":22,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-17T13:33:33.115Z","updated_at":"2026-08-17T13:33:33.115Z","tags":[{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"category","value":"Hematology","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"condition","value":"Immune Thrombocytopenia","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"condition","value":"Intracranial Hemorrhage","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"generic","value":"recombinant factor VIIa","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"generic","value":"tranexamic acid","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"modality","value":"Antifibrinolytic","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"modality","value":"Corticosteroid","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"modality","value":"Intravenous Immunoglobulin","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"modality","value":"Platelet Transfusion","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"modality","value":"Splenectomy","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"modality","value":"Thrombopoietin Receptor Agonist","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"study_design","value":"Clinical Practice Guideline","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"warning","value":"Level of evidence assigned as '3' reflects the guideline panel's reliance on retrospective cohort data and systematic reviews rather than randomized trials; the panel itself rated certainty as low to very low. The formal GRADE level may vary by institution's hierarchy.","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"warning","value":"Study design is labeled 'Clinical Practice Guideline' but incorporates an original multicenter retrospective cohort study; these are distinct components of the publication.","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025018818","tag_type":"warning","value":"The guideline covers both adult and pediatric ITP but does not report a single aggregate sample size; no sample_size tag was emitted.","value_numeric":null}],"summaries":{"what_studied":"This guideline evaluated the emergency management of critical bleeding (e.g., intracranial hemorrhage, hemodynamically unstable bleeding) in adults and children with immune thrombocytopenia (ITP), using GRADE methodology informed by a multicenter retrospective cohort study and systematic reviews.","key_result":"Strong recommendations were made for the combined use of high-dose corticosteroids, high-dose IV immunoglobulin (IVIG), platelet transfusions, tranexamic acid, and TPO receptor agonists (TPO-RAs) in both adults and children with a critical ITP bleed — despite low or very low certainty in the evidence. Urgent splenectomy received a conditional recommendation when other treatments fail; recombinant factor VIIa received a conditional recommendation **against** use due to thrombosis risk.","limitations":"- All recommendations are based on low or very low certainty evidence, reflecting the rarity of critical ITP bleeds and lack of randomized controlled trials.\n- The supporting cohort study was retrospective and multicenter, limiting causal inference.\n- No head-to-head comparisons of treatment combinations were available.","practice_takeaway":"When an ITP patient presents with a critical bleed, use all five interventions together: high-dose corticosteroids, high-dose IVIG, platelet transfusions, tranexamic acid, and a TPO-RA — don't wait to see if one works before adding another. Avoid recombinant factor VIIa given its thrombosis risk; consider urgent splenectomy only as a last resort."}},{"doi":"10.1001/jamasurg.2025.5498","pmid":"41405985","title":"Perioperative Use of Tranexamic Acid in General Surgery","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2025-12-17T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12712826/","source_score":138,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2025-12-19","doi":"10.1001/jamasurg.2025.5498","days":"30","issn":"2168-6254","rank":"4","field":"Clinical Medicine","score":"138","category":"Surgery","categories":["Surgery"],"_categories":["Surgery"]},"pubmed":{"doi":"10.1001/jamasurg.2025.5498","title":"Perioperative Use of Tranexamic Acid in General Surgery: A Systematic Review and Meta-Analysis.","journal":"JAMA surgery","methods":"","results":"Twenty-six RCTs with a total of 6976 patients were included. TXA use was associated with lower intraoperative blood loss (MD, -35.85 mL; 95% CI, -57.20 to -14.51 mL; I2 = 91%; P = .001), reduced need for transfusion (RR, 0.75; 95% CI, 0.60-0.94; I2 = 54%; P = .01), and fewer major bleeding events (RR, 0.72; 95% CI, 0.59-0.89; I2 = 0%; P = .002). No significant differences were found in venous thromboembolism (RR, 1.09; 95% CI, 0.62-1.92; I2 = 15%; P = .75), mortality (RR, 1.08; 95% CI, 0.72-1.61; I2 = 0%; P = .71), and length of stay (MD, -0.54 days; 95% CI, -1.15 to 0.06 days; I2 = 73%; P = .08). In the subgroup analysis restricted to abdominal procedures, the benefits observed in the overall population on intraoperative blood loss and need for transfusion were no longer present. In the hepatobiliary subgroup, TXA was associated with a significant reduction in major bleeding (RR, 0.59; 95% CI, 0.39-0.90; I2 = 0%; P = .01), while no significant differences were observed for the other outcomes.","abstract":"$30","keywords":[],"pubmed_id":"41405985","conclusions":"","publication_date":"2025-12-17T00:00:00"},"crossref":{"DOI":"10.1001/jamasurg.2025.5498","URL":"https://doi.org/10.1001/jamasurg.2025.5498","ISSN":["2168-6254"],"link":[{"URL":"https://jamanetwork.com/journals/jamasurgery/articlepdf/2843043/jamasurgery_delgado_2025_oi_250084_1765563894.45277.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Perioperative Use of Tranexamic Acid in General Surgery"],"author":[{"given":"Lucas Monteiro","family":"Delgado","sequence":"first","affiliation":[{"name":"Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil"}]},{"given":"Bernardo 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Benefits for blood loss and transfusion were not seen in abdominal-only procedures; in hepatobiliary surgery, major bleeding decreased (RR 0.59; 95% CI 0.39-0.90; I2=0%).","limitations":"Heterogeneity was high for blood loss (I2=91%) and length of stay (I2=73%); effects varied by procedure, with abdominal-only procedures showing no benefit for blood loss or transfusion; safety estimates were imprecise, with wide CIs for venous thromboembolism and mortality.","practice_takeaway":"For adults undergoing general surgery, prophylactic TXA modestly reduces bleeding and transfusion without a detected rise in VTE or death; consider procedure-specific effects—benefits were clearer in hepatobiliary surgery and not observed for abdominal-only procedures."}}],"initialOffset":10,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"generic","value":"tranexamic acid"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Generics","href":"/hub/tag/generic"},{"name":"tranexamic acid"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"generic","hub_tag_value":"tranexamic acid"}}}]]

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