Extended-use high-dose IV tranexamic acid does not improve mortality or bleeding outcomes and increases adverse events. Low-dose/enteral tranexamic acid may be effective in reducing hemorrhage; more evidence is required to demonstrate its safety.

5 randomized controlled trials evaluated extended-use high-dose IV tranexamic acid, seven evaluating low-dose IV or enteral tranexamic acid.

Extended-use high-dose IV tranexamic acid did not reduce mortality or bleeding but resulted in a small increase in deep venous thrombosis, pulmonary embolism, and seizure (relative risk, 1.73; 95% CI, 1.03–2.93) with high certainty.

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