Tranexamic acid-induced seizures in parturient patient during sectio caesarean
Case report
Keywords:
hypocalcemia, pregnancy, seizures, tranexamic acidAbstract
Introduction: Tranexamic acid has found extensive application in obstetrics to prevent and treat postpartum hemorrhage (PPH). This case report investigated an infrequent incidence in which seizures were caused by the administration of tranexamic acid. Even though tranexamic acid is generally regarded as safe, it has been associated with the infrequent yet serious side effects of tranexamic acid-induced seizures. This case report was aimed at investigating the infrequent incidence of tranexamic acid-induced seizures in postpartum patients. Case: It was reported that a woman who was 40 weeks pregnant suffered from postpartum seizures after delivery via cesarean section. These seizures occurred after tranexamic acid was administered to treat postpartum hemorrhage (PPH) caused by uterine rupture, which was accompanied by hypocalcemia. Despite not having a history of epilepsy, preeclampsia, or hypertension, the electrocardiogram (EKG) showed a prolongation of the QT interval. A comprehensive diagnostic evaluation, which involved a CT scan of the head and a D-dimer examination, was conducted, revealing no abnormalities. Discussion: Tranexamic acid, a synthetic derivative of lysine, acts as a competitive inhibitor of plasminogen activation, thereby inhibiting the breakdown of fibrin clots.
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Aya, A. G. M., Ondze, B., Ripart, J., & Cuvillon, P. (2016). Seizures in the peripartum period: epidemiology, diagnosis and management. Anaesthesia Critical Care & Pain Medicine, 35, S13-S21. https://doi.org/10.1016/j.accpm.2016.06.010
Bell, K. T., Salmon, C. M., Purdy, B. A., & Canfield, S. G. (2023). Evaluation of Tranexamic Acid and Calcium Chloride in Major Traumas in a Prehospital Setting: A Narrative Review. Shock, 60(3), 325-332.
Bharath, K., Bhagat, H., & Mohindra, S. (2011). Use of tranexamic acid as a rescue measure to achieve hemostasis after massive blood loss in a pediatric neurosurgical patient. Journal of neurosurgical anesthesiology, 23(4), 376-377.
Catalano, A., Chilà, D., Bellone, F., Nicocia, G., Martino, G., Loddo, I., ... & Loddo, S. (2018). Incidence of hypocalcemia and hypercalcemia in hospitalized patients: Is it changing?. Journal of clinical & translational endocrinology, 13, 9-13. https://doi.org/10.1016/j.jcte.2018.05.004
Hart, L. A., & Sibai, B. M. (2013). Seizures in pregnancy: epilepsy, eclampsia, and stroke. In Seminars in perinatology (Vol. 37, No. 4, pp. 207-224). WB Saunders. https://doi.org/10.1053/j.semperi.2013.04.001
Jolly, M. C., Sebire, N., Harris, J., Robinson, S., & Regan, L. (2000). Obstetric risks of pregnancy in women less than 18 years old. Obstetrics & Gynecology, 96(6), 962-966. https://doi.org/10.1016/S0029-7844(00)01075-9
Kawagishi, M., Kaku, N., Shin, S., & Tsumura, H. (2022). Generalized tonic-clonic seizure caused by tranexamic acid administration in spinal surgery: a case report and literature review. Journal of orthopaedic case reports, 12(6), 5.
Kurniati, A., Wantonoro, W., & Rokhanawati, D. (2022). Pregnant woman’s knowledge to the danger signs of pregnancy. International Journal of Health & Medical Sciences, 5(4), 276-285. https://doi.org/10.21744/ijhms.v5n4.1953
Lecker, I., Wang, D. S., Whissell, P. D., Avramescu, S., Mazer, C. D., & Orser, B. A. (2016). Tranexamic acid–associated seizures: causes and treatment. Annals of neurology, 79(1), 18-26.
Lin, Z., & Xiaoyi, Z. (2016). Tranexamic acid-associated seizures: a meta-analysis. Seizure, 36, 70-73. https://doi.org/10.1016/j.seizure.2016.02.011
Luo, H., Shen, C., Qu, T., Chen, L., Sun, Y., & Ren, Y. (2023). Tranexamic acid-induced focal convulsions after spinal surgery: a rare case report and literature review on side effects of accidental spinal administration of tranexamic acid. EFORT Open Reviews, 8(6), 482-488.
Maalouf, N. M., Heller, H. J., Odvina, C. V., Kim, P. J., & Sakhaee, K. (2006). Bisphosphonate-induced hypocalcemia: report of 3 cases and review of literature. Endocrine Practice, 12(1), 48-53. https://doi.org/10.4158/EP.12.1.48
Maged, A. M., Helal, O. M., Elsherbini, M. M., Eid, M. M., Elkomy, R. O., Dahab, S., & Elsissy, M. H. (2015). A randomized placebo-controlled trial of preoperative tranexamic acid among women undergoing elective cesarean delivery. International Journal of Gynecology & Obstetrics, 131(3), 265-268. https://doi.org/10.1016/j.ijgo.2015.05.027
Montroy, J., Hutton, B., Moodley, P., Fergusson, N. A., Cheng, W., Tinmouth, A., ... & Breau, R. H. (2018). The efficacy and safety of topical tranexamic acid: a systematic review and meta-analysis. Transfusion Medicine Reviews, 32(3), 165-178. https://doi.org/10.1016/j.tmrv.2018.02.003
Novikova, N., Hofmeyr, G. J., & Cluver, C. (2015). Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database of Systematic Reviews, (6).
Ruys, T. P., Cornette, J., & Roos-Hesselink, J. W. (2013). Pregnancy and delivery in cardiac disease. Journal of cardiology, 61(2), 107-112. https://doi.org/10.1016/j.jjcc.2012.11.001
Shakur?Still, H., Roberts, I., Grassin?Delyle, S., Chaudhri, R., Geer, A., Arribas, M., ... & Balogun, E. (2023). Alternative routes for tranexamic acid treatment in obstetric bleeding (WOMAN?PharmacoTXA trial): a randomised trial and pharmacological study in caesarean section births. BJOG: An International Journal of Obstetrics & Gynaecology, 130(10), 1177-1186.
Simonazzi, G., Bisulli, M., Saccone, G., Moro, E., Marshall, A., & Berghella, V. (2016). Tranexamic acid for preventing postpartum blood loss after cesarean delivery: a systematic review and meta?analysis of randomized controlled trials. Acta obstetricia et gynecologica Scandinavica, 95(1), 28-37.
Taeuber, I., Weibel, S., Herrmann, E., Neef, V., Schlesinger, T., Kranke, P., ... & Meybohm, P. (2021). Association of intravenous tranexamic acid with thromboembolic events and mortality: a systematic review, meta-analysis, and meta-regression. JAMA surgery, 156(6), e210884-e210884.
Zehtabchi, S., Baki, S. G. A., Falzon, L., & Nishijima, D. K. (2014). Tranexamic acid for traumatic brain injury: a systematic review and meta-analysis. The American journal of emergency medicine, 32(12), 1503-1509. https://doi.org/10.1016/j.ajem.2014.09.023
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