Extensive Stroke Associated with Tranexamic Acid Therapy

Abstract

Stroke in young adults accounts for almost 5-10% of all acute strokes 1 . Acute ischemic stroke in young adults requires a wide etiological study since it is usually due to infrequent or unusual causes of stroke. Frequently, the association of several prothrombotic conditions, such as prothrombotic drug therapy, increases the risk of acute ischemic stroke in young adults. CASE REPORTA 38-year-old woman was admitted to the hospital because of sudden, right-sided weakness and impaired language expression and comprehension. The patient had a history of tuberculosis ten years prior and of thrombophlebitis in the lower-left limb five months prior. She was taking oral contraceptives. Three weeks before admission she started treatment with daily tranexamic acid (500 mg tid) under gynecological supervision due to onset of active metrorrhagia, but no other risk factors for vascular disease were present.The patient had been well until the day of admission. The morning of hospital admission the patient had sudden rightsided hemiparesis and impaired language expression and comprehension.On examination, the mucous membranes were pale. The blood pressure was 110/65 mm Hg, and the pulse 100 beats per minute. The respiratory rate was 14 breaths per minute and oxygen saturation 93%, while she was breathing ambient air. She was not able to follow simple commands, nor to repeat words, name objects or speak at all. The pupils were round and reactive to light and the eyes were conjugately deviated to the left. There was a lack of menace reflex on the right side, a right-side facial droop, a right hemiplegia and a Babinski reflex of the right big toe (National Institute of Health Stroke Scale = 17). The computerized tomography and the cranial magnetic resonance imaging revealed an extensive middle cerebral artery (MCA) infarct (Figure). The administration of intravenous tPA thrombolysis was ruled out because of active metrorrhagia.The serum levels of electrolytes and the results of renal and liver function tests were normal. Hemoglobin concentration was 7.7 g/dL. Coagulation parameters were normal. Antinuclear, anti-neutrophil cytoplasmic and anticardiolipin antibodies all were negative. The lupus-anticoagulant was also negative. The proteinogram was normal. The plasmatic homocisteine level was 16.4 umol/L [4-15 umol/L]. Tumor markers (carcinoembryonic antigen, carbohydrate antigen 19.9, cancer-antigen 125, alpha phetoprotein and β-2 microglobulin) were normal. The hereditary thrombophilia test, including Factor V Leiden, protein C, protein S and antithrombin 3, was negative. The eco-Doppler

Comparative Analysis of Tranexamic Acid Use in Minimally Invasive Versus Open Craniosynostosis Procedures

“…To counterbalance that notion, however, we point out that caution is still advised. Reports from the pediatric surgical literature have identified stroke, 33 myoclonus, 34 seizures, 35 and allergic reactions 36 as the primary serious adverse events associated with perioperative use of antifibrinolytics. Our decision to discontinue TXA administration at the end of surgery may explain the lack of drug-related complications in our patients, because most of these have been reported with prolonged use into the postoperative period.…”

Stroke in Young Women

“…Tranexamic acid has been associated with stroke in case reports, although other risk factors were present. [49][50][51][52] It may therefore be prudent to avoid OC and prothrombotic agents in patients with endometriosis who have a concurrent history of MA and/or other stroke risk factors. Non-systemic therapies for endometriosis may be preferable in these situations.…”