Updated Cochrane review on antifibrinolytics for bleeding prevention in people with haematological disorders

Individuals with haematological disorders often face a high risk of severe or even life-threatening bleeding due to thrombocytopenia, commonly caused by the underlying disease or chemotherapeutic agents, or both. This is despite routine prophylaxis with platelet transfusion once the platelet count drops below a certain threshold. Platelet transfusions carry risks and may cause serious adverse events. This updated Cochrane systematic review examined antifibrinolytics as adjuncts to prophylactic platelet transfusion, specifically the lysine analogues, tranexamic acid (TXA) and epsilon aminocaproic acid (EACA).  

The review evaluated the benefits and harms of TXA or EACA in preventing bleeding among people with haematological disorders requiring prophylatic platelet transfusion. It included 8 randomized controlled trials (RCTs), 4 of which were new, covering a total of 1,041 participants (evidence current to January 2025). Six trials compared TXA to placebo. Bleeding severity was assessed using the WHO bleeding scale. 

The review found that, compared to placebo, “For people with thrombocytopenia and haematological malignancies, TXA probably has little or no effect on clinically significant bleeding (grade 2 or higher), and it may also have little or no effect on severe or life‐threatening bleeding (grade 3 or higher) or thromboembolism. The evidence for all‐cause mortality and serious adverse events from antifibrinolytic drugs is very uncertain.” For EACA, data was insufficient to draw conclusions. 

The findings of this Cochrane review are predominantly based on 2 RCTs (TXA in high‐resource settings: A‐TREAT 2022 and TREATT 2025) and included a range of haematological malignancies. Due to insufficient data, subgroup analysis by underlying diagnosis or treatment could not be conducted.  

Reference: 

• Champaneria R, Estcourt LJ, Geneen L, Brunskill SJ, Dorée C, Stanworth SJ, Desborough MJR. Antifibrinolytics (lysine analogues) for the prevention of bleeding in people with haematological disorders. Cochrane Database of Systematic Reviews 2026, Issue 2. SN: 1465-1858. DOI: 10.1002/14651858.CD009733.pub4  

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009733.pub4/full