NYMC Faculty Publications

ST Elevation Myocardial Infarction After Tranexamic Acid: First Reported Case in the United States

Author Type(s)

Faculty

DOI

10.1097/MJT.0b013e31828fdb06

Journal Title

American Journal of Therapeutics

First Page

221

Last Page

224

Document Type

Article

Publication Date

1-1-2014

Department

Medicine

Keywords

Antifibrinolytic Agents, Arthroplasty, Replacement, Hip, Coronary Angiography, Electrocardiography, Female, Humans, Middle Aged, Myocardial Infarction, Percutaneous Coronary Intervention, Thrombectomy, Tranexamic Acid, United States

Disciplines

Medicine and Health Sciences

Abstract

Antifibrinolytic agents, such as tranexamic acid (TA), aprotinin, and E-aminocaproic acid, have been extensively used in the past 2 decades to prevent blood loss from traumatic or postoperative bleeding. For example, the Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage 2 (CRASH-2) trial demonstrated that there was a significant reduction in all-cause mortality in trauma patients treated with TA (relative risk=0.91, P=0.003) and death due to bleeding (relative risk=0.85, P=0.007). This article reports the case of a 56-year-old woman without any previous cardiac history who was admitted to the hospital for an elective right hip arthroplasty and who received 1 dose of 10 mg/kg of TA. Her immediate postoperative course was complicated by hypotension and chest pain, and an electrocardiogram showed ST segment elevation in the inferior leads. Emergent coronary angiography showed complete occlusion of the distal right coronary artery that was successfully treated with thrombectomy and percutaneous coronary intervention. An extensive literature search showed only 4 cases of myocardial infarction in the setting of TA administration, all of which were outside the United States.

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