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Case Report
Nebulized tranexamic acid directly causing transient left bundle branch block
1 DO, Internal Medicine Resident, Mercy Medical Center-North Iowa, 1000 4th St SW, Mason City, IA 50401, USA
2 MBBS, Medical Research Assistant, Mercy Medical Center-North Iowa, 1000 4th St SW, Mason City, IA 50401, USA
3 MD, Department of Cardiology-Electrophysiology, Mercy Medical Center-North Iowa, 1000 4th St SW, Mason City, IA 50401, USA
4 MD, Department of Critical Care, Mercy Medical Center-North Iowa, 1000 4th St SW, Mason City, IA 50401, USA
Address correspondence to:
Katharine Lasley Woods
Mercy-ONE North Iowa, 1000 4th St SW, Mason City, IA 50401,
USA
Message to Corresponding Author
Article ID: 100086Z06KW2020
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Woods KL, Nagraj S, Germano N, Koranne K, Summerfield DT. Nebulized tranexamic acid directly causing transient left bundle branch block. Case Rep Int 2020;9:100086Z06KW2020.ABSTRACT
Introduction: Tranexamic acid (TXA) is an antifibrinolytic with applications in preventing potentially life-threatening hemorrhage.
Case Report: A 39-year-old male presented with massive hemoptysis and, during treatment with TXA, developed a transient left bundle branch block (LBBB). He was recently initiated on warfarin, but then developed a pulmonary hemorrhage. Along with standard treatments, it was decided to administer inhaled TXA to assist with hemodynamic stabilization. On persistent telemetry monitoring in the critical care unit, during administration of his first nebulized dose of TXA, a new onset LBBB was observed. Electrocardiogram (EKG) findings resolved to normal sinus rhythm within 30 minutes of TXA discontinuation. A second round of inhaled TXA was administered 8 hours later during which the LBBB reoccurred. It resolved within approximately 30 minutes without demonstration of troponin increase.
Conclusion: To our knowledge, this is the first described instance of EKG changes seen after administration of inhaled TXA; therefore, caution should be exercised particularly in those with concomitant cardiovascular disease.
Keywords: Bundle branch block, Hemoptysis, Tranexamic acid
SUPPORTING INFORMATION
Acknowledgments
We would like to thank Dr. Peter L Larsen for providing our team with guidance and editorial support.
Author ContributionsKatharine Lasley Woods - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sanjana Nagraj - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Drafting the article, Final approval of the version to be published
Nicholas Germano - Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Ketan Koranne - Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Douglas T Summerfield - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Katharine Lasley Woods et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
