The efficacy of prophylactic tranexamic acid in patients with hematologic malignancy: a systematic review and meta-analysis.

Bleeding is a major complication in patients with hematologic malignancies, who frequently develop severe thrombocytopenia. The effectiveness of prophylactic tranexamic acid (TXA) in reducing clinically bleeding remains uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials to evaluate whether prophylactic TXA reduces WHO grade ≥ 2 bleeding and transfusion requirements. Studies enrolling adults receiving chemotherapy, immunotherapy, or hematopoietic stem cell transplantation, or those expected to develop severe thrombocytopenia were eligible; studies including patients with prior thromboembolism, therapeutic anticoagulation, or platelet transfusion refractoriness were excluded. MEDLINE, EMBASE, and Cochrane CENTRAL were searched through April 2025. Two reviewers independently extracted data, assessed risk of bias with the Cochrane RoB 2 tool, and synthesized results using random-effects meta-analysis. Six trials involving 1086 participants were included. TXA showed little to no reduction in WHO grade ≥ 2 bleeding compared with control (OR 0.84, 95% CI 0.64-1.12; moderate certainty). For other outcomes, TXA had minimal effects on red blood cell and platelet transfusion requirements (low certainty), and thromboembolic events were uncommon, with no clear signal of increased risk (low certainty). Prophylactic TXA likely offers limited clinical benefit for patients with hematologic malignancies but appears generally safe.