The Clinical Utility of Tranexamic Acid in the Management of Refractory Bleeding in a Patient With Advanced Liver Disease

Abstract

Advanced liver disease is associated with coagulopathy and bleeding that develops from several mechanisms. In common clinical practice, the bleeding is treated with blood products and/or pharmacologic agents based on their corrective effect on laboratory tests of hemostasis. We report the case of a 72-year-old man with end-stage liver disease with refractory bleeding in whom multiple therapeutic strategies failed, including massive blood product replacement, but who responded to the infusion of tranexamic acid, an anti-fibrinolytic agent. The hyper-fibrinolytic state is difficult to diagnose with conventional clinical laboratory tests, but it was suspected in this patient with refractory bleeding and hypo-fibrinogenemia. Although largely used in the surgical setting, tranexamic acid may prove useful in medical settings characterized by bleeding and systemic fibrinolysis.




J Hematol. 2014;3(2):46-49
doi: http://dx.doi.org/10.14740/jh151w