Examining the effect of Tranexamic Acid (TXA) on the functional fibrinolysis assay in patients with hereditary bleeding disorder (HBD) compared with healthy controls.

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It is routine practice at the Haemophilia Treatment Centre at The Alfred that patients who undergo dental extraction or low risk endoscopic procedures receive tranexamic acid (TXA) with or without factor concentrate replacement (depending on proceduralist determined bleeding risk). Despite clinical reports of no increased rate of bleeding utilising this strategy, the underlying biological mechanism has not been extensively explored. We aim to evaluate the impact of TXA on functional fibrionolysis by enrolling such patients and healthy controls into the proposed study. Enrolled patients will ingest one gram of oral tranexamic acid on the day of procedure and blood will be collected immediately before and 4 hours post ingestion. Plasma samples will be prepared and stored for evaluation of fibrinolysis utilising contemporary clot lysis assay. Correlation of the results will be made with clinical bleeding as reported by the proceduralist who are blinded to the results. Healthy volunteer subjects will also take a dose of one gram of tranexamic acid and have plasma samples collected at 2,4, and 8 hours post ingestion. Fibrinolysis will be measured using a light transmission based assay where thrombin and tissue plasminogen activator are added to the plasma. The expected effect of tranexamic acid is a delay in fibrinolysis in the control samples. In the patient samples, it is expected that clot formation will be impaired by the bleeding disorder but the tranexamic acid may similarly delay fibrinolysis when compared with controls.

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