Anaphylaxis with Associated Fibrinolysis, Reversed with Tranexamic Acid and Demonstrated by Thrombelastography

Souza, R L De; Short, Timothy G.; Warman, Guy R.; MacLennan, Neil; Young, Y.

doi:10.1177/0310057x0403200419

Cited by 31 publications

(11 citation statements)

References 18 publications

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“…We identified seven additional articles on hyperfibrinolysis diagnosed by thromboelastography. Oozing from the wound surface was observed in one patient reported by De Souza et al [18], whereas no bleeding complications were found in the other reports. Although four patients in whom the hyperfibrinolysis occurred during surgery were administered tranexamic acid and fresh frozen plasma intraoperatively, hyperfibrinolysis of the other three patients was resolved spontaneously within a few hours.…”

Section: Discussionmentioning

confidence: 73%

Utility of rotational thromboelastometry for the diagnosis of asymptomatic hyperfibrinolysis secondary to anaphylaxis

Koami

Sakamoto²,

Furukawa³

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

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We present a case of hyperfibrinolysis induced by oxaliplatin-derived anaphylactic shock, which was diagnosed with rotational thromboelastometry (ROTEM). A 57-year-old male patient underwent a second course of oxaliplatin (126 mg/m/course)-based chemotherapy for stage IV metastatic rectal cancer. Two minutes after the infusion of oxaliplatin, the patient lost consciousness and developed generalized urticarial lesions, followed by hemodynamic instability and respiratory insufficiency. He was diagnosed anaphylactic shock and transported to emergency department (ED) after intramuscular injection of 0.2 mg of adrenaline, an intravenous injection of 100 mg of hydrocortisone, and 500 mg of methylprednisolone. After arriving in the ED, the patient remained in shock and early resuscitation with administration of 5 mg of D-chlorpheniramine maleate and 20 mg of famotidine was performed. He recovered from his state of shock 30 min after the resuscitation. ROTEM findings showed fulminant hyperfibrinolysis with minimal changes in standard coagulation tests (SCTs) and no remarkable coagulopathy. Seven hours after the attack, he became asymptomatic and follow-up ROTEM revealed values within normal limits with the exception of sustained slight abnormalities of SCTs. He was discharged the next day without any signs of spontaneous bleeding and has continued his outpatient chemotherapy uneventfully. A review of the literature on anaphylaxis-induced hyperfibrinolysis and a discussion of the mechanism between anaphylactic shock and hyperfibrinolysis were performed. Although administration of tissue-type plasminogen activator can play a vital role in anaphylactic shock-induced hyperfibrinolysis, early effective resuscitation is imperative to prevent severe hemorrhagic complications. Therefore, ROTEM is a useful tool that can detect these dynamic changes faster and more accurately than SCTs.

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Section: Discussionmentioning

confidence: 73%

Utility of rotational thromboelastometry for the diagnosis of asymptomatic hyperfibrinolysis secondary to anaphylaxis

Koami

Sakamoto²,

Furukawa³

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

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“…Koami et al [4] described a case of oxaliplatin-induced anaphylaxis associated with hyperfibrinolysis demonstrated by ROTEM TM (rotational thromboelastometry) with spontaneous resolution and no bleeding sequelae. De Souza et al [5] reported a series of four cases of anaphylaxis-induced hyperfibrinolysis demonstrated by thromboelastography (TEG). They were all treated with tranexamic acid and one was also treated with fresh frozen plasma after which the TEG returned to normal.…”

Section: Discussionmentioning

confidence: 99%

Dysfibrinogenaemia secondary to rocuronium‐induced anaphylaxis

Orr

Rosser

2017

Anaesthesia Cases

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“…However, if the surgery is emergent and must be continued, any hemodynamic instability should be managed judiciously. Fibrinolysis during anaphylaxis has been reported and should be kept in mind as it could increase the risk of perioperative bleeding [14]. …”

Section: Discussionmentioning

confidence: 99%

Anaphylactic reactions after cisatracurium administration in two patients -a report of two cases-

Yoon

Lee

Seo

et al. 2013

Korean J Anesthesiol

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Cisatracurium was initially characterized to have no evident histamine-releasing potential with excellent cardiovascular stability. However, severe anaphylactic reactions to cisatracurium that resulted in bronchospasms and cardiovascular collapse have been reported worldwide. Two cases of severe anaphylactic reactions after the administration of cisatracurium are presented. The anesthetics used in both cases were lidocaine, midazolam, propofol (microemulsion propofol in the second case), remifentanil and cisatracurium. After the administration of these drugs, bronchospasm and hypotension manifested, leading to the diagnosis of anaphylaxis and appropriate treatment. Skin intradermal testing confirmed that both cases were due to immune-mediated anaphylaxis to cisatracurium, despite the fact that neither of the patients had been exposed to the allergen previously. The anaphylaxis may be due to cross-reactivity between neuromuscular blocking agents and substances with quaternary ammonium ions. Anesthesiologists should be aware that cisatracurium has the potential to trigger severe anaphylactic reactions via an immune-mediated mechanism.

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Anaphylaxis with Associated Fibrinolysis, Reversed with Tranexamic Acid and Demonstrated by Thrombelastography

Cited by 31 publications

References 18 publications

Utility of rotational thromboelastometry for the diagnosis of asymptomatic hyperfibrinolysis secondary to anaphylaxis

Utility of rotational thromboelastometry for the diagnosis of asymptomatic hyperfibrinolysis secondary to anaphylaxis

Dysfibrinogenaemia secondary to rocuronium‐induced anaphylaxis

Anaphylactic reactions after cisatracurium administration in two patients -a report of two cases-

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