Tranexamic acid (TA) act as anti-fibrinolytic agent and is widely used to limit bleeding in clinical practice. Tranexemic acid bind with plasminogen and prevent its conversion to plasmin, which limits the fibrinolytic pathway, so there is a theoretical risk of increasing thrombosis with high or prolonged therapy with TA. We encountered a case of acute arterial thrombosis following inadvertent administration of high dose of TA. A 27-years-old male with no other co-morbidity was ordered intravenous 1 gm TA to control excessive bleeding from previous bladder injury, but by mistake, he received 10 gm of TA. The patient developed signs and symptoms of acute ischemia in the right lower limb, which was diagnosed as acute iliac arterial thrombosis by computed tomography (CT) angiography. The patient was managed with systemic heparinization, fasciotomy for impending gangrene and other supportive care following which he recovered fully within a few days. Caution should be exercised for all prophylactic use, especially with high dosage or prolonged therapy with TA.
CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage: A randomised, placebo controlled trial. The Lancet 2010;376:23-32.
Dzik WH, Blajchman MA, Fergusson D, Hameed M, Henry B, Kirkpatrick AW, et al. Clinical review: Canadian National Advisory Committee on Blood and Blood Products: Massive Transfusion Consensus Conference 2011: Report of the panel. Critical Care 2011;15:242.
Ramstrom G, Blomback M, Egberg N, Johnsson H, Ljungberg B, Schulman S. Oral surgery in patients with hereditary bleeding disorders. A survey of treatment in the Stockholm area (1974-1985). Int J Oral Maxillofac Surg 1989;18:320-2.
Endo Y, Nishimura S, Miura A. Deep-vein thrombosis induced by tranexamic acid in idiopathic thrombocytopenic purpura [letter]. JAMA 1988;259:3561-2.
Taparia M, Cordingley FT, Leahy MF. Pulmonary embolism associated with tranexamic acid in severe acquired haemophilia. Eur J Haematol 2002;68:307-9.
Rydin E, Lundberg PO. Tranexamic acid and intracranial thrombosis. Lancet 1976;2:49.
Ruth Savage. Thrombosis with Tranexamic Acid for Menorrhagia. Prescriber Update 2003;24:26-7.
Hardy JF, Belisle S, Dupont C, Harel F, Robitaille D, Roy M. Prophylactic tranexamic acid and epsilon-aminocaproic acid for primary myocardial revascularization. Ann Thorac Surg 1998;65:371-6.
Sundström A, Seaman H, Kieler H, Alfredsson L. The risk of venous thromboembolism associated with the use of tranexamic acid and other drugs used to treat menorrhagia: A case-control study using the General Practice Research Database. BJOG 2009;116:91-7.