Talk About Tranexamic Acid

Recently, the addition of tranexamic acid to Yunnan Baiyao toothpaste has become a hot topic on the Internet. Many doctors have interpreted this matter from their own professional point of view. For example, some stomatologists clearly pointed out that the important thing for gingival bleeding is not to stop but to treat, and hemostatic drugs are likely to cover up symptoms and delay patients' treatment. Most of these interpretations have played a good role in science popularization.

However, it has to be said that there are also individual medical colleagues who are not careful enough to speak on this issue, and they have made some unprofessional remarks on the basis of insufficient understanding of relevant professional knowledge, which has artificially increased the panic.

For example, some doctors claim that adding tranexamic acid to toothpaste will lead to the risk of thrombosis for toothpaste users, and so on. It caused some unnecessary panic.There is a doctor big V declared: the amount of tranexamic acid in toothpaste does not play a hemostatic effect, and there is no difference between adding and not adding.

The above remarks are a little irresponsible.

If you want to add western medicine to Chinese herbal toothpaste, you may need to write several articles. In today's article, Bao first tells you what kind of drug chutranexamic acid is.

I dare say that even many medical experts may not know enough about this drug.The first thing to say is that tranexamic acid is a real miracle drug - it's not ironic.

For Yunnan Baiyao, we don't know its specific ingredients, so we can't judge whether Yunnan Baiyao is effective or not, and we can't know how much the added western medicine has played. But one thing is clear: the added western medicine component tranexamic acid is a safe and effective hemostatic drug.

1. History of tranexamic acid

Tranexamic acid, also known as tranexamic acid, is a synthetic lysine derivative, belonging to antifibrinolytic agent. In 1962, the Japanese female doctor Okamoto discovered that it was mainly intended to prevent postpartum hemorrhage. However, due to Japan's unequal attitude towards professional women at that time, Ko Ko never succeeded in persuading obstetricians in her hospital to try the drug.

Its real clinical application began in 1968. Vermylen J and his colleagues conducted a simple double-blind clinical study on patients with menorrhagia. In June 1970, J pediatr Surg of Elsevier published the first clinical study on postoperative hemostasis. J.S. R ü and his colleagues from Norway selected 10 children undergoing urological surgery to use tranexamic acid, which proved to be effective in reducing blood transfusion after surgery.

By 2010, tranexamic acid had been repeatedly tested in clinical trials by scholars from all over the world, proving its powerful efficacy and high safety. At that time, the wording of the BBC's report on this matter was: if this long discovered drug can be taken seriously and given to trauma patients with severe blood loss, at least 100000 lives will be saved every year. (Up to 100,000 lives could be saved every year if a known drug were given to seriously bleeding trauma patients. ).

Gradually, tranexamic acid has been widely used in various surgical operations to stop bleeding and trauma.

 

2. Can tranexamic acid in toothpaste cause thrombosis?

The main role of tranexamic acid in clinical is hemostasis and coagulation. By binding with lysine binding site on fibrinolytic enzyme molecule, tranexamic acid competitively inhibits the adsorption of plasminogen on fibrin, thus inhibiting the activation of plasminogen, so that fibrinolytic protein is not degraded by plasmin, so as to achieve the effect of anti fibrinolysis and hemostasis. It is an anti fibrinolytic agent amino 7-10 times of hexanoic acid.

Tranexamic acid is an effective and safe hemostatic drug, which can prevent the clot formed and block the bleeding mouth from dissolving, but does not change the activity of thrombin.

In other words: in theory, tranexamic acid's role is to prevent the clots blocking the bleeding point from dissolving, rather than promoting the clotting process to cause thrombosis.

In the 2014 revised manual of tranexamic acid, the article 7 of adverse reactions is described as follows: it is reported after global marketing that patients with hemophilia are excluded and rare thromboembolism events are used within the scope of indications.

As an efficient and safe hemostatic drug, the amount of toothpaste added must be extremely small, and brushing teeth belongs to external use, and generally will not be swallowed. Worried about the amount of blood clots in the toothpaste, a Bao felt that he was a little over anxious.

In fact, adding tranexamic acid to toothpaste is not illegal. The composition of toothpaste basically refers to cosmetic raw materials. According to the 2015 edition of the catalogue, tranexamic acid is a permitted ingredient (cosmetic list No. 04866) and is not on the prohibited list.

On the other hand, this proves that tranexamic acid added to toothpaste is safe. There is no need to panic at all.

 

3. Tranexamic acid -- a global classic hemostatic drug

Tranexamic acid has been on the market for more than 50 years, and the annual consumption of tranexamic acid is still more than 400 million. It is included in the official Pharmacopoeia of China, the United States, Japan, Europe and other countries. It is the only classic hemostatic drug that has been widely used in clinical application for half a century.

Tranexamic acid not only withstood the test of time, but also increased academic attention. It is a safe and effective hemostatic drug recommended by authoritative guidelines at home and abroad. For example:

"Expert consensus on the application of sequential anticoagulants in perioperative period of hip and knee arthroplasty in China" (2015)

"China orthopedic surgery accelerated rehabilitation - expert consensus on perioperative blood management" (2017)

Guidelines for perioperative blood management anti fibrinolytic therapy in cardiovascular surgery (2016 Edition)

European Society of Anesthesiology guidelines for the management of perioperative severe bleeding (2017)

European guidelines for the management of severe traumatic bleeding and coagulation diseases (2016)

American Heart Association / American Stroke Association guidelines for the management of aneurysmal subarachnoid hemorrhage (2012)

World Health Organization (who) recommendations for prevention and treatment of postpartum hemorrhage (updated in 2012)

International Society of minimally invasive cardiothoracic surgery expert consensus 2011 "drugs, instruments, techniques and methods for blood management in minimally invasive and traditional cardiac surgery"

American Thoracic Surgery and American Association of Cardiovascular Anesthesiologists clinical practice guidelines for blood protection (2011)

American Heart Association / American Stroke Association guidelines for the management of aneurysmal subarachnoid hemorrhage (2012)

……

In addition, tranexamic acid is also recommended by the latest clinical pathway in China.

4. Other uses of tranexamic acid

With the wide application of tranexamic acid, people began to find that it also has an interesting "side effect", that is, whitening and freckle removing. The whitening effect of tranexamic acid is obvious. The efficacy of removing black spots is about 50 times higher than that of vitamin C and nearly 10 times of that of fruit acid. This makes tranexamic acid more famous.

It is generally believed that the mechanism of tranexamic acid whitening and freckle removal is related to tyrosinase. There are two possible mechanisms: first, it can directly compete with tyrosine and interfere with the catalytic effect of tyrosinase on tyrosine metabolism. 2, It may also inhibit melanin formation by inhibiting plasminogen fibrinolysis system, interfering with the interaction between melanocytes and keratinocytes, and reducing tyrosinase activity.

Therefore, tranexamic acid is not only widely used in the treatment of chloasma, but also added to a variety of cosmetics for whitening, such as Shiseido whitening products.(Hangzhou lianzheng chemical Co.,ltd supplies the same raw material with Shiseido use)

 

 

"Whitening needles" made with other drugs such as vitamin C and glutathione are also popular. Who can think of thousands of yuan a course of treatment of "whitening needle" really play a role is more than a dozen yuan a tranexamic acid?

In addition, tranexamic acid also has anti-inflammatory effect, which can inhibit the production of coagulating peptides and other active peptides that cause increased vascular permeability, allergic reaction and inflammatory lesions, so as to achieve anti allergic and anti-inflammatory effects. In terms of anti-inflammatory, tranexamic acid also has a lot of clinical evidence.

 

Therefore, the addition of tranexamic acid in toothpaste can not only play a hemostatic effect, but also anti-inflammatory and detumescence.

So the problem comes. Since tranexamic acid is a drug that can completely cover the anti-inflammatory, swelling and hemostatic effects of Yunnan Baiyao toothpaste, what's the use of the traditional Chinese medicine ingredients? And, since tranexamic acid is so cheap, why is toothpaste so expensive?

Well, everyone is free to prove that it is a secret recipe