Myoclonus associated with tranexamic acid administration in a patient on veno-arterial extracorporeal membrane oxygenation support: A case report

BACKGROUND: Tranexamic acid (TXA) is widely used as an antifibrinolytic agent to reduce bleeding in cardiac and extracorporeal circulation settings. Neurological adverse effects, including seizures and myoclonus, are rare and not well documented in patients supported by extracorporeal membrane oxygenation (ECMO). CASE SUMMARY: We report the case of a 52-year-old male with ST-elevation myocardial infarction and severe left ventricular dysfunction, who was transferred to our intensive care unit department under veno-arterial (VA)-ECMO support and continuous renal replacement therapy (CRRT). To maintain ECMO oxygenator function and due to decreasing fibrinogen levels, endovenous one gram TXA twice a day was administered and within hours after the second dose, the patient developed generalized myoclonic jerks. A non-contrast brain computed tomography revealed no acute or chronic abnormalities, and neurological evaluation attributed the findings to TXA as the most likely cause due to TXA overdose. Following discontinuation of TXA, the symptoms resolved within 48 hours. CONCLUSION: This case highlights a rare neurological complication associated with TXA overdose, occurring in patient with VA-ECMO and CRRT. Clinicians should remain vigilant for such adverse effects in this context.