Tranexamic Acid in Trauma: Case of a Young Woman Highlights Risk of Acute Renal Cortical Necrosis
France: A recent case published in BMC Nephrology highlights the possible role of tranexamic acid (TXA) in precipitating acute bilateral renal cortical necrosis (RCN) in a young trauma patient, raising concerns about its administration, especially in the presence of additional thrombotic risk factors.
The researchers note that TXA is used widely as an antifibrinolytic agent in managing postpartum hemorrhage and severe traumatic bleeding. However, its potential association with renal cortical necrosis remains unclear, with only a few reported cases in non-obstetric settings. Previous reports on TXA-induced RCN suggest a rapid onset of acute kidney injury (AKI), with most cases requiring hemodialysis. The recovery of renal function varies, with some patients remaining dialysis-dependent.
Manal Mazloum, University of Montpellier, Montpellier, France, and colleagues describe the case of a 24-year-old woman with no prior medical history who was admitted to intensive care following a high-energy car accident. Despite stable hemodynamics and the absence of active arterial hemorrhage, she received an initial 1 g dose of TXA along with supportive therapy. Shortly after administration, her blood pressure dropped, necessitating norepinephrine support, which was quickly tapered. Laboratory investigations ruled out disseminated intravascular coagulation (DIC) and thrombotic microangiopathy (TMA), but 48 hours later, she developed AKI with anuria and rising serum creatinine levels, requiring hemodialysis.
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