abstract
- Context Our case highlights the underappreciated thrombotic risks of tranexamic acid use in non-cardiac surgery and emphasizes the need to elucidate these risks with appropriate clinical trials.The use of tranexamic acid (TXA) in non-cardiac surgery has significantly expanded in the past five years, especially after the 2010 publication of the CRASH-2 Trial. We submit a case with the intent to highlight the thrombotic risk of TXA use during non-cardiac surgery and discuss the need for careful risk stratification before the use of TXA in this context.A 66 year-old male with long standing HIV infection, hypertension, and no history of coronary artery disease (CAD) presented for revision spinal fusion surgery with the use of TXA, is presented.To limit perioperative blood loss, the case patient received TXA intraoperatively. His operative course was uneventful.During the first 12 hours postoperatively he was noted to have persistent tachycardia and ST-elevation on ECG. Echocardiography showed a new apical wall motion abnormality and a left ventricle thrombus; cardiac catheterization confirmed two-vessel CAD, treated with a bare-metal stent and anticoagulation.The thrombotic risks of TXA use in non-cardiac surgery have yet to be adequately studied in clinical trials. Hence, TXA use in this context is still an area of uncertainty and its thrombogenic risks have yet to be studied as a primary outcome in any large prospective trial to date. Patients with any hypercoagulable risk factors, including HIV infection or any prior thrombotic history, in which TXA use is being considered should prompt a discussion amongst the perioperative physicians involved.Copyright © 2015. Published by Elsevier Inc.