Tranexamic acid (TXA) is widely utilized to control perioperative
bleeding. TXA is considered a safe
drug with few serious adverse effects, but many studies report TXA-associated
seizures, especially with cardiac surgeries. Usually, TXA-associated
seizures persist for a few minutes with no progression into
status epilepticus. Here, we report, for the first time, a case of refractory
status epilepticus after IV injection of TXA in a paediatric non-cardiac surgery. This case report and literature review aim to increase awareness about TXA-associated
seizures and to provide mechanistic-based prevention and treatment recommendations. During adenotonsillectomy for a 4-year-old male child, TXA infusion started after induction of anaesthesia for surgical
bleeding prophylaxis. During recovery from anaesthesia, the patient developed
tonic-clonic convulsions which did not improve after two IV doses of
midazolam but showed an improvement after a dose of
propofol. The patient did not regain consciousness and was transferred to the ICU. He had recurrent treatment-resistant attacks of
tonic-clonic convulsions. The patient developed
acute kidney injury and died after 18 hours. In high-risk patients, using the lowest effective dose with early termination of TXA infusion and prolongation of administration of anaesthetics may prevent
seizures. General anaesthetics (
propofol and halogenated inhaled anaesthetics) are considered the first line for prevention/treatment of TXA-associated
seizures.