B64-45 From Local to Systemic: Ischemic Stroke Following Nebulized Tranexamic Acid
Abstract
Tranexamic acid (TXA) is an antifibrinolytic agent that inhibits fibrinolysis by blocking the lysine-binding sites on plasminogen. It has been shown to decrease mortality from hemorrhagic shock in trauma and childbirth. Although some studies have suggested a possible association between intravenous TXA and venous thromboembolisms, this relationship remains unclear. Nebulized TXA is indicated in the treatment of hemoptysis with minimal systemic absorption. We report a case of ischemic stroke following administration of nebulized TXA for diffuse alveolar hemorrhage in the setting of hepatopulmonary syndrome, possibly due to systemic absorption of TXA from intrapulmonary shunting.
A 49-year-old man with ILD and chronic hypoxemic respiratory failure, COPD, and alcoholic liver cirrhosis, presented with acute on chronic hypoxic respiratory failure. An echocardiogram with bubble study revealed an intrapulmonary shunt, which, in the setting of cirrhosis, raised concern for hepatopulmonary syndrome. Bronchoalveolar lavage confirmed diffuse alveolar hemorrhage (DAH) with rising BAL RBC count (from 3000 RBCs/µL to 14,000 RBCs/µL to 27,000 RBCs/µL), likely secondary to coagulopathy from liver cirrhosis (platelet count 45 x 103/µL, INR 1.4). When on maximal high flow nasal cannula therapy (100%, 40L) with persistent drops in SpO2, he was started on nebulized TXA for DAH at 500 mg TID. Following administration of nebulized TXA his oxygen requirement decreased to 6L NC. Approximately…
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