Left atrial thrombi following tranexamic acid in a bleeding trauma patient—A word of caution

Left atrial thrombi following tranexamic acid in a bleeding trauma patient—A word of caution INTRODUCTIONAntifibrinolytic agents such as aminocaproic acid and tranexamic acid (TXA) have been utilized for decades to control peri‐procedural bleeding in cardiac, orthopedic, urologic, and dental procedures and more recently as an adjunct to trauma.TXA has a high affinity for the lysine binding site on plasminogen and this inhibits binding to fibrin, which prevents activation of plasmin and the breakdown of clots. The ability of TXA to strengthen clots and limit hemorrhage was demonstrated in vivo as early as the 1970s, and is now being applied in the trauma setting. The large‐scale, multinational, randomized CRASH‐2 trial showed significantly decreased mortality with the administration of TXA in over 20 000 bleeding trauma patients. Timing is critical, as greater mortality reduction is seen with earlier administration.However, TXA has been implicated in the development of vasoocclusive events, although analysis of CRASH‐2 trial participants indicated no difference in the incidence of vasoocclusive events or related deaths with the administration of TXA over placebo. We describe a bleeding trauma patient who received TXA during air transport to our hospital. Although the patient was hemodynamically stable on arrival, imaging revealed the presence of unusual intra‐cardiac masses.PATIENT PROFILEA 31‐year‐old Caucasian female was involved in a single vehicle rollover. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Cardiac Surgery Wiley

Left atrial thrombi following tranexamic acid in a bleeding trauma patient—A word of caution

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Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
© 2018 Wiley Periodicals, Inc.
ISSN
0886-0440
eISSN
1540-8191
D.O.I.
10.1111/jocs.13521
Publisher site
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Abstract

INTRODUCTIONAntifibrinolytic agents such as aminocaproic acid and tranexamic acid (TXA) have been utilized for decades to control peri‐procedural bleeding in cardiac, orthopedic, urologic, and dental procedures and more recently as an adjunct to trauma.TXA has a high affinity for the lysine binding site on plasminogen and this inhibits binding to fibrin, which prevents activation of plasmin and the breakdown of clots. The ability of TXA to strengthen clots and limit hemorrhage was demonstrated in vivo as early as the 1970s, and is now being applied in the trauma setting. The large‐scale, multinational, randomized CRASH‐2 trial showed significantly decreased mortality with the administration of TXA in over 20 000 bleeding trauma patients. Timing is critical, as greater mortality reduction is seen with earlier administration.However, TXA has been implicated in the development of vasoocclusive events, although analysis of CRASH‐2 trial participants indicated no difference in the incidence of vasoocclusive events or related deaths with the administration of TXA over placebo. We describe a bleeding trauma patient who received TXA during air transport to our hospital. Although the patient was hemodynamically stable on arrival, imaging revealed the presence of unusual intra‐cardiac masses.PATIENT PROFILEA 31‐year‐old Caucasian female was involved in a single vehicle rollover.

Journal

Journal of Cardiac SurgeryWiley

Published: Jan 1, 2018

References

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