Tranexamic acid

The case of a 33y old man is presented, who after a car accident, was transferred to the ED with a right hip dislocation and slightly obtunded but in a stable hemodynamic condition. After an emergent CT scan, a thoracic aortic rupture along with intestine rupture and retroperitoneal hematoma were noted. The patient was administered 1 g tranexamic acid (TXA) and 1 g fibrinogen concentrate (FC) preoperatively and then was transferred to the OR, where primarily, under monitored anesthetic care (MAC) the aortic trauma was restored intraluminally and then, under general anesthesia, he underwent laparotomy and hip dislocation reduction. During operation, no diffuse bleeding was noted, nor was any transfusion of blood or blood product necessary. After a short ICU stay the patient was discharged in good general health state. The aim of this case report is to present a case of traumatic aortic rupture bleeding, effectively managed with prophylactic tranexamic acid (TXA) and fibrinogen concentrate (FC) administration without need of any kind of transfusion. Continue reading

Scoliosis is a musculoskeletal disorder, in which there is a sideways curvature of the spine. Surgical correction of scoliosis is a long-lasting high-risk procedure, which can lead to serious complications such as pulmonary embolism and substantial haemorrhage. In our case a 20 year-old male with idiopathic scoliosis curve of 82o underwent a reconstructive spinal surgery. Tranexamic acid (TXA) i.v infusionwas used intraoperatively to reduce the blood loss. The operation took 8h to complete and proceeded well without complications. Afterwards the patient was then transferred to ICU. The third postoperative day he was admitted back to the orthopedic ward. 7h after admission he presented clinical symptoms of pulmonary embolism (PE). The suspicion of a pulmonary embolism was confirmed by an emergency CT pulmonary angiogram. Consequently, the patient was again admitted to the ICU and was treated with LMWH in a therapeutic dose. Three days later he returned back to the orthopedic ward clinically stabilized and with normal ABGs. In this case report the cause and origin of pulmonary embolism was not clear. The patient was treated with chemical thromboprophylaxis (LMWH) from the first postoperative day and yet PE was not prevented.This event contradicts the supposed rarity of PE after correction of AIS surgery. It also results in a controversy over the efficacy of LMWH on reducing the incidence of VTE and over the safety and proper dosing of TXA.

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