Serum-Level Profile of Tranexamic Acid and Development of Seizures in a Patient With End-Stage Renal Disease After Receiving Artificial Hip Replacement

BACKGROUND: The authors reported a 73-year-old woman with end-stage renal disease who underwent artificial hip replacement. METHODS: Clinicians monitored tranexamic acid serum levels along with the incidence of central nervous system symptoms and hemodialysis. RESULTS: Intravenous tranexamic acid was administered thrice 30 minutes before the surgery, and at 5 hours (2 hours after surgery) and 16 hours (13 hours after surgery) thrice after the first dosing (surgical time: 150 minutes). Although no seizure or its related symptoms were observed before the first hemodialysis, the involuntary movements appeared at the start of hemodialysis. High tranexamic acid serum levels (81.5-116.3 μg/mL) were maintained for 25 hours from the initial dosing. The seizure and its related symptoms rapidly disappeared with the single administration of diazepam immediately after the seizures. Tranexamic acid was discontinued after seizures, and the patient underwent hemodialysis at 49, 97, and 145 hours after the first dosing. Serum levels at 45, 120, and 168 hours after first dosing were 19.2, 10.9, and 8.1 μg/mL, respectively. CONCLUSIONS: Continuous exposure to high serum levels of tranexamic acid may cause seizures.