Abstract
Tranexamic acid (TXA) is an antifibrinolytic agent that is commonly used in cardiac, gynecologic, and obstetric surgeries. Inadvertent intrathecal injection of the TXA may lead to serious side effects including myoclonus, seizure, and ventricular fibrillation. So far, the proconvulsive properties of TXA and its mechanism of action are poorly understood. Medical error leads to serious adverse effects that can be attributed to similar appearance of ampoules, location of ampoules, and incorrect labeling of prefilled syringes. We herein report a case of refractory status epilepticus after accidental intrathecal injection of TXA. The patient was treated with thiopentone infusions until achieving a burst suppression pattern on electroencephalogram along with other antiepileptic drugs. Subsequently, the patient recovered completely without any neurological deficit. To the best of our knowledge, this is the first case of refractory status epilepticus after inadvertent intrathecal injection of TXA. Such catastrophic complications can be avoided by vigilance, correct labeling of syringes and ampoules, double checking medications prior to administration, and preventing manufacturing of vials of different drugs with similar appearance.
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