Editorial Views  |   July 2017
Understanding Potential Drug Side Effects: Can We Translate Molecular Mechanisms to Clinical Applications?
Author Notes
  • From the Institute of Anesthesiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Ruhr-University Bochum, Germany (A.K.); and Department of Anesthesiology, Cardiac Anesthesiology and Critical Care, Duke University School of Medicine, Durham, North Carolina ( J.H.L.).
  • Corresponding article on page 89.
    Corresponding article on page 89.×
  • Accepted for publication January 26, 2017.
    Accepted for publication January 26, 2017.×
  • Address correspondence to Dr. Koster: akoster@hdz-nrw.de
Article Information
Editorial Views / Cardiovascular Anesthesia / Central and Peripheral Nervous Systems
Editorial Views   |   July 2017
Understanding Potential Drug Side Effects: Can We Translate Molecular Mechanisms to Clinical Applications?
Anesthesiology 7 2017, Vol.127, 6-8. doi:10.1097/ALN.0000000000001666
Anesthesiology 7 2017, Vol.127, 6-8. doi:10.1097/ALN.0000000000001666
CLINICAL pharmacology is one important basis of modern anesthesiology. In this month’s edition of Anesthesiology, Lecker et al.1  report the results of an investigation of high concentrations of tranexamic acid (TXA) on N-methyl-d-aspartate (NMDA) and glutamate receptors in cultured murine hippocampal neurons. The investigation was prompted by reports of seizures in patients receiving TXA during cardiac surgery. It is an excellent example of “reverse translation”: taking clinical problems to the laboratory to understand their etiology and mechanism.
The role of antifibrinolytic therapy for bleeding continues to expand in medical practice. The antifibrinolytic agent most extensively used in 2016 is the lysine analog TXA, a drug developed in the 1950s by Okamoto Utakoin in Japan when searching for a therapy to treat postpartum hemorrhage. From the late 1960s until today TXA has been used in a growing number of surgical and nonsurgical settings to reduce bleeding including menorrhagia, cardiac surgery, orthopedic surgery, and in trauma. The results of the Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage 2 (CRASH-2) trial in trauma patients had a major impact on its growing use in clinical practice.2  TXA also is used for prophylaxis in patients with hereditary angioedema and may have important antiinflammatory effects as a protease inhibitor.3  Despite this extensive use, reported side effects are infrequent.4  In 2009 TXA acid was entered into the World Health Organization list of essential medicines.
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