American Trial Using Tranexamic Acid in Thrombocytopenia
Condition: Thrombocytopenia
MeSH terms: Thrombocytopenia
Intervention: Tranexamic Acid; Placebo
Intervention description: Doses will be given intravenous (IV) or orally (PO) per the discretion of the treating investigator. Doses are administered every 8 hours. When given IV, TXA 1.0 gram will be administered. When given PO, TXA 1.3 grams will be administered; Doses will be given intravenous (IV) or orally (PO) per the discretion of the treating investigator. Doses are administered every 8 hours. When given IV, Normal Saline will be administered. When given PO, placebo pills will be administered
Intervention MeSH terms: Tranexamic Acid
Phase: Phase 3
Study type: Interventional
Primary purpose: Prevention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 330.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Thrombocytopenia; Tranexamic Acid; TXA; Chemotherapy induced thrombocytopenia

Summary:

      The purpose of this study is to evaluate the usefulness of antifibrinolytic therapy with
      tranexamic acid (TXA) in preventing bleeding in patients who are thrombocytopenic due to
      primary bone marrow disorders or chemotherapy, immunotherapy and/or radiation therapy.
    

Eligibility criteria:

        Inclusion criteria (all must be met):

          -  Must be ≥ 18 years of age

          -  Confirmed diagnosis of a hematologic malignancy or aplasia

          -  Undergoing or planned chemotherapy, immunotherapy, or hematopoietic stem cell
             transplantation

          -  Anticipated to have hypoproliferative thrombocytopenia resulting in a platelet count
             of ≤ 10,000/microliters for ≥ 5 days

          -  Able to provide informed consent and comply with treatment and monitoring, or having a
             Legally Authorized Representative (LAR)

        Exclusion criteria (none can be present):

          -  Diagnosis of acute promyelocytic leukemia undergoing induction chemotherapy

          -  History of ITP, TTP or HUS

          -  Subjects receiving L-asparaginase as part of their current cycle of treatment

          -  Subjects with a past history or current diagnosis of arterial or venous thromboembolic
             disease including acute coronary syndrome, peripheral vascular disease and retinal
             arterial or venous thrombosis (except when a prior history of central line thrombosis
             has resolved)

          -  Subjects with a diagnosis/previous history of sinusoidal obstruction syndrome (also
             called veno-occlusive disease)

          -  Subjects receiving any pro-coagulant agents (e.g. DDAVP, recombinant Factor VIIa or
             Prothrombin Complex Concentrates (PCC) and/or an antifibrinolytic agent within 48
             hours of enrollment, or with known hypercoagulable state

          -  Known inherited or acquired bleeding disorder including, but not limited to:

               -  Acquired storage pool deficiency

               -  Paraproteinemia with platelet inhibition

          -  Known inherited or acquired prothrombotic disorders, including antiphospholipid
             syndrome. Those with lupus anticoagulant or positive antiphospholipid serology without
             thrombosis are not excluded.

          -  Subjects receiving anticoagulant therapy or anti-platelet therapy (except when
             receiving prophylactic anticoagulant or low dose aspirin therapy for prophylaxis only
             with a plan to discontinue when the platelet count falls below 50,000)

          -  Patients with DIC according to the patient's physician

          -  Subjects with WHO Grade 2 bleeding or greater within 48 hours prior to activation

          -  Subjects requiring a platelet transfusion threshold > 10,000/microliters at time of
             randomization

          -  Subjects with anuria (defined as urine output < 10mls/hr over 24 hours)

          -  Subjects on dialysis

          -  Subjects with creatinine ≥5.7mg/dL

          -  Subjects who are pregnant or nursing or unwilling to use contraception during and for
             30 days after taking the study drug (both males and females)

          -  Subjects enrolled in other trials involving platelet transfusions, anti-fibrinolytics,
             platelet growth factors or other pro-coagulant agents.

          -  Known allergy to tranexamic acid

          -  Having been previously randomized in this study at any stage of their treatment

          -  Subjects who are unwilling to accept blood or blood component transfusions