Tranexamic acid
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Acute ischaemic stroke: 2 case reports Two women, aged 44 and 49 years, developed acute ischaemic strokes while receiving tranexamic acid for bleeding gynaecological disorders [outcomes not stated]. The younger woman, who had a history of migraine with aura, was admitted due to the acute onset of left hemiplegia, dysarthria and anosognosia. Her recent medical history was notable for bleeding due to curettage for voluntary abortion 1 week earlier, and the intake of oral tranexamic acid 500mg daily from 3 days. Examination revealed moderate-severe hemiplegia with hypotonia in the left side, hypoelicitability on the right side, and the absence of tendon reflexes on the left side. Anosognosia and mild dysarthria were also apparent. Brain imaging studies showed a right ischaemic fronto-temporal lesion and subocclusion of the right middle cerebral artery. Genetic analysis revealed heterozygosity for MTHFR C677T. The older woman, who had a history of migraine with aura, was referred after the acute onset of asphasia and right hemiplegia. Her recent medical history was notable for excessive uterine bleeding due to curettage for uterine fibromatosis 8 days earlier, and the intake of oral tranexamic acid 500mg daily from 3 days. Examination revealed moderate-severe hemiplegia in the right side, with hypotonus. Tendon reflexes were absent on the right side and severe asphasia was apparent. A left ischaemic capsular and periventricular lesion was evident on brain MRI, and angiography revealed a near occlusion of the left internal carotid artery, with an occlusion of the left middle cerebral artery. Laboratory analysis was notable for an increase in leucocyte count, which reduced over the following days, and microcytic anaemia. Genetic analysis revealed heterozygosity for MTHFR C677T. Author comment: "[W]e hypothesized that the tranexamic acid administration could be related to the stroke onset because of a permissive genetic background." Nardi K, et al. Ischaemic stroke following tranexamic acid in young patients carrying heterozygosity of MTHFR C677T. Annals of Clinical Biochemistry 48: 575-578, No. 6, Nov 2011. Available from: URL: http://dx.doi.org/10.1258/ 803068353 acb.2011.011101 - Italy
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Reactions 24 Mar 2012 No. 1394
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