Among thrombocytopenic patients with hematological disorders, prophylactic bolus dosing of tranexamic acid appears to be statistically noninferior continuous infusion, according to results of the BRAVE trial presented at the ISTH 2022 Congress.

Previous research and clinical data have shown that tranexamic acid and other antifibrinolytic agents help to prevent bleeding events among patients with hemostatic challenges. These therapeutic strategies have, in preceding years, become central to mitigating blood loss in this patient population.

The elimination half-life of these drugs is approximately 2 hours. It was not previously known whether intermittent bolus dosing of tranexamic acid yields inferior outcomes to continuous infusions. For this randomized prospective study, researchers compared these 2 dosing strategies among patients with different hematological scenarios with bleeding challenges.

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Overall, 35 patients were enrolled, of whom 49% were randomly assigned to the bolus dosing arm and 51% were assigned to the continuous infusion arm. All included patients were aged 18 years or older and had a confirmed diagnosis of acute myeloid leukemia, acute lymphoblastic leukemia, immune thrombocytopenia, or aplastic anemia. Baseline characteristics were matched between the 2 arms.

Analysis after treatment showed that, in the bolus dosing vs continuous infusion arms, the mean duration of bleeding was not significantly different (P =.469); the mean grade of bleeding (0.76 vs 0.72, respectively; P =.29), mean number of platelet transfusions (4.24 vs 3.28; P =.65), and duration of hospital stay (15.41 vs 12.33 [no units noted]; P =.508) showed numerically, but not statistically significant, differences.

“Bolus dosing of tranexamic acid is as effective as continuous infusion for prophylactic use in thrombocytopenic patients with hematological disorders,” the authors wrote.


Poojitha B, Modak K, Pavitra DS, Joseph MJ, Ashwin P. Comparison between intermittent bolus versus continuous intravenous infusion of tranexamic acid in hematological disorders with thrombocytopenia (BRAVE trial). Poster presented at: ISTH 2022 Congress; July 9-12, 2022. Abstract VPB0637.