From the Guidelines
Tranexamic acid (TXA) can cause seizures, particularly at higher doses, as evidenced by studies showing a dose-dependent relationship between TXA administration and seizure risk. TXA works by inhibiting the breakdown of blood clots and is commonly used to control bleeding in various medical situations. The risk of seizures with TXA appears to be dose-dependent and is more likely to occur with high doses, rapid intravenous administration, or in patients with certain risk factors, such as pre-existing seizure disorders, brain injuries, renal impairment, or when TXA is administered directly to the central nervous system during neurosurgical procedures 1.
Key Points to Consider
- The mechanism behind TXA-induced seizures involves its ability to block inhibitory neurotransmitters in the brain, specifically by inhibiting GABA and glycine receptors, which can lead to neuronal hyperexcitability.
- A maximum total dose of 100 mg/kg is recommended to minimize the risk of seizures 1.
- Healthcare providers typically weigh the benefits of TXA against these potential risks when prescribing the medication.
- If you are taking TXA and experience symptoms such as confusion, visual disturbances, or unusual muscle movements, you should seek immediate medical attention.
Clinical Guidance
- TXA should be administered with caution in patients with risk factors for seizures.
- Monitoring for signs of seizures, such as confusion, visual disturbances, or unusual muscle movements, is essential when administering TXA.
- The benefits of TXA in reducing bleeding and transfusion requirements should be carefully balanced against the potential risks of seizures, particularly in patients with underlying risk factors 1.
From the FDA Drug Label
Tranexamic acid may cause seizures, including focal and generalized seizures. Serious adverse reactions including seizures and cardiac arrythmias have occurred when tranexamic acid was inadvertently administered intrathecally instead of intravenously Inform patients that tranexamic acid may cause seizures and to contact their healthcare provider for any signs or symptoms suggestive of seizures
Yes, tranexamic acid (TXA) can cause a seizure, including focal and generalized seizures, especially when administered incorrectly via the intrathecal route instead of intravenously 2, 2.
From the Research
TXA and Seizure Risk
- The relationship between tranexamic acid (TXA) and seizure risk has been investigated in several studies 3, 4, 5, 6.
- A systematic review and meta-analysis found that TXA did not increase the risk of seizures in bleeding patients, but high doses (>2g/day) may be associated with an increased risk 3.
- Another study found that a 2-g bolus of TXA was not associated with increased seizures in patients with moderate or severe traumatic brain injury 4.
- A national database analysis found that TXA administration during total joint arthroplasty surgery was not associated with an increased risk of perioperative seizures 5.
Mechanism of TXA-Induced Seizures
- TXA has been shown to inhibit glycine receptors, which can lead to seizures 6.
- The concentration of TXA in the cerebrospinal fluid (CSF) of patients undergoing major cardiovascular surgery has been found to be associated with the onset of seizures 6.
- Isoflurane and propofol may be able to prevent or reverse TXA-induced seizures by reversing TXA inhibition of glycine receptor-mediated current 6.
Dose-Dependent Effects of TXA
- A meta-regression analysis found that the risk of seizures increased with increasing doses of TXA 3.
- High doses of TXA (>2g/day) may be associated with an increased risk of seizures, while lower doses may not be associated with an increased risk 3.
- Further studies are needed to fully understand the dose-dependent effects of TXA on seizure risk 7.