Tranexamic Acid: An Exceedingly Rare Cause of Anaphylaxis during Anaesthesia

Abstract

Tranexamic acid (TXA) allergy is extremely rare. An 80-year-old woman without prior exposure to TXA underwent elective knee replacement. Shortly after induction of anaesthesia and intravenous TXA, she developed hypotension, tachycardia, and facial erythema accompanied by a raised serum tryptase. Later, skin prick and intradermal testing confirmed positive responses to TXA in high dilution and with negative results to the other drugs used. While neuromuscular blocking agents, opiates, and antibiotics remain the most frequent cause of anaphylaxis during anaesthesia, allergy to TXA should always be borne in mind and requires skin testing for confirmation as there are presently no blood tests available.

Two Cases of Anaphylaxis to Tranexamic Acid Confirmed by Drug Provocation Test: What About Skin Testsing?

“…After that, we performed TXA 10 mg/mL, but also stopped because of 2/11 positive results. Finally, we tested TXA 2 mg/mL, and 14/14 were negative.Despite previous studies [6,7], our study has shown that IDT with undiluted TXA should not be performed because of an irritating concentration, andIDT with TXA 10 mg/mL should be carefully interpreted because of a risk of false positive results.If TXA anaphylaxis is suspected, we suggest performing SPT with undiluted TXA and IDT up to 2 mg/ml, followed by, if negative, DPT.…”

“…Due to similar chemical structures and potential common epitopes, other lysine derivatives such as aminocaproic acid should be avoided [8]. Etamsylate seems to be a safe alternative [7][8][9].…”

Comparison of different dosage regimes of epsilon aminocaproic acid on blood loss in children undergoing craniosynostosis surgery

“…Although there appears to be benefits of decreased blood loss and transfusion with antifibrinolytics administration, there are potential side effects. These may present as thrombosis, seizures and anaphylaxis . A recent publication investigating the safety of antifibrinolytics in this patient population showed no differences in seizures or thrombotic events in patients receiving antifibrinolytics versus those that did not .…”

“…These may present as thrombosis, seizures and anaphylaxis. 22,23 A recent publication investigating the safety of antifibrinolytics in this patient population showed no differences in seizures or thrombotic events in patients receiving antifibrinolytics versus those that did not. 24 In most cases, the benefits of reducing blood loss and transfusion outweigh the rare side effects, but clinicians should evaluate every patient on a case by case basis.…”

Tranexamic acid adverse reactions: a brief summary for internists and emergency doctors

“…Fifteen year ago, the first case of anaphylaxis caused by TXA was reported [16]. Thereafter, the interest in TXA hypersensitivity arose [17]. To date several cases of TXA adverse reactions have been reported especially in perioperative medicine subsets.…”