Tranexamic acid
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Atrial thrombosis and pulmonary thromboembolism in a child: case report A 3-year-old boy developed right atrial thrombosis and bilateral pulmonary thromboembolism after receiving tranexamic acid; he subsequently died. The boy underwent surgical closure of an atrial septal defect. After anticoagulation with heparin, a cardiopulmonary bypass was established. The protocol included three boluses of tranexamic acid 10 mg/kg [route not stated], administered at the beginning of surgery, during the 25-minute bypass and at the end of the procedure. The surgery was completed uneventfully; however, on the way to an ICU, he suddenly developed severe hypotension, bradycardia and hypoxaemia. The boy underwent aggressive resuscitation with dopamine, dobutamine and epinephrine [adrenaline]. Echocardiography revealed large thrombi in the right atrium and signs of pulmonary hypertension indicative of pulmonary thromboembolism. He was returned to an operating room, and a cardiopulmonary bypass was re-established. During repeat chest surgery, large amounts of right atrial thrombus were removed; however, no thrombus could be recovered on pulmonary embolectomy, indicating the thrombus had embolised to small pulmonary arteries. He was then weaned off cardiopulmonary bypass, and received heparin. Repeat echocardiography revealed new right atrial thrombus formation and persistent pulmonary hypertension. Despite receiving thrombolysis with recombinant thromboplastin activator [sic], he developed upper body oedema over the next 24 hours. He also developed nasopharyngeal bleeding secondary to thrombolysis and anticoagulation. Follow-up echocardiography showed a new left atrial thrombus and further thrombus formation in the right atrium. He died on postoperative day 5 [cause of death not stated]. Postmortem analysis confirmed extensive right atrial thrombosis and diffuse bilateral pulmonary thromboembolism, as well as a large left atrial thrombus. Author comment: "The second theoretical possibility is the use of tranexamic acid as part of our standard hemostatic protocol. This antifibrinolytic agent may have created conceivably a prothrombotic state akin to that which used to be seen with aprotinin." Gonz´alez-Calle A, et al. Right atrial thrombosis and pulmonary embolism after atrial septal defect repair. European Journal of Cardio-Thoracic Surgery 41: 224-225, No. 1, Jan 2012. Available from: URL: http://dx.doi.org/10.1016/ 803085354 j.ejcts.2011.05.035 - Spain
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Reactions 6 Apr 2013 No. 1446
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