Bilateral Pulmonary Embolism While Receiving Tranexamic Acid: A Case Report

A Case Report

Ezekiel Oluwasayo Ijaopo; Ruth Oluwasolape Ijaopo; Sampson Adjei

Disclosures

J Med Case Reports. 2020;14(212) 

In This Article

Abstract and Introduction

Abstract

Background: We present a case of a suspected tranexamic acid–related bilateral pulmonary embolism in a healthy and active middle-aged woman who was receiving tranexamic acid for menorrhagia with no other known significant risk factors for thromboembolism.

Case Presentation: A 46-year-old Asian woman who was usually fit and well with no remarkable past medical history except for menorrhagia of 1-year duration for which she was receiving tranexamic acid presented to our accident and emergency department with a 2-week history of intermittent pleuritic central chest pain. She was reviewed and discharged to home with a diagnosis of musculoskeletal pain on two hospital visits because she had no significant risk factors for thromboembolism and her workup investigation results for pulmonary embolism and other differential diagnoses were largely unremarkable. On her third visit to the emergency ambulatory clinic with recurring symptoms of pleuritic chest pain, a pulmonary computed tomographic angiogram confirmed bilateral subsegmental pulmonary embolism.

Conclusion: This case report reinforces the possible increased risk of thromboembolism in patients receiving tranexamic acid.

Introduction

Pulmonary embolism (PE) is a common medical condition and remains life-threatening despite advances in its diagnosis and treatment past few decades. The incidence of PE is estimated to be approximately 60 to 70 per 100,000 in the general population.[1] However, the true incidence is far more than what is reported, because PE remains one of the most commonly underdiagnosed medical problems. It is believed to be responsible for 100,000 deaths per year in the United States.[2] In Europe, cases of PE affect 6 to 20 per 10,000 people per year, and 7–11% of people with PE do not survive.[3] If untreated, mortality of acute PE is as high as 30%, whereas the death rate of diagnosed and treated PE is 8%.[1] The confirmation of acute PE diagnosis via lung imaging relies on the history, physical examination, and a high index of clinical suspicion.[4] Prompt diagnosis and treatment are therefore imperative to reduce the morbidity and mortality of PE. This case report provides increased awareness for clinicians on how a commonly prescribed tranexamic acid (TXA) can be a potential cause of PE, particularly in patients considered to have very low risk factors for venous thromboembolism (VTE).

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