Antiviral Effects of TXA as a Preventative Treatment Following COVID-19 Exposure
Status:
Withdrawn
Trial end date:
2023-03-31
Target enrollment:
Participant gender:
Summary
A recent report in Physiolological Reviews proposed that the endogenous protease plasmin acts
on SARS-CoV-2 by cleaving a newly inserted furin site in the S protein portion of the virus
resulting in increased infectivity and virulence. A logical treatment that might blunt this
process would be the inhibition of the conversion of plasminogen to plasmin. Fortunately,
there is an inexpensive, commonly used drug, tranexamic acid, TXA, which suppresses this
conversion and could be re-purposed for the treatment of COVID-19. TXA is a synthetic analog
of the amino acid lysine which reversibly binds four to five lysine receptor sites on
plasminogen. This reduces conversion of plasminogen to plasmin, and is normally used to
prevent fibrin degradation. TXA is FDA approved for the outpatient treatment of heavy
menstrual bleeding (typical dose 1300 mg p.o. TID x 5 days) and off-label use for many other
indications. TXA is used perioperatively as a standard-of-care at UAB for orthopedic and
cardiac bypass surgeries. It has a long track record of safety such that it is used
over-the-counter in other countries as an antiviral and for the treatment of cosmetic
dermatological disorders. Given the potential benefit and limited toxicity of TXA it would
appear warranted to perform randomized, double-blind placebo controlled exploratory trial at
UAB as a prophylactic antiviral treatment following exposure to COVID-19 in order to
determine whether it reduces infectivity and virulence of the SARS-CoV-2 virus as
hypothesized. Involvement of each patient is only for 7 days before primary endpoints and 30
days for final data collection.