Page 53 - World Journal of Laparoscopic Surgery

CASE REPORT
Pulmonary Thromboembolism While Receiving Tranexamic

Acid after Laparotomy Myomectomy: A Case Report

3
2
1
5
4
Shahla Noori Ardabili , Atefeh Zeinali , Rajneesh Kumar Mishra , Samaneh Chegeni , Ali Mehrafshar , Nooshin Noori 6
Received on: 21 February 2022; Accepted on: 20 May 2022; Published on: 05 September 2023
AbstrAct
Aim: We aimed to review a case with pulmonary thromboembolism while using tranexamic acid after laparotomy myomectomy.
Background: Pulmonary embolism (PE) is life-threatening and early diagnosis and proper treatment are crucial.
Case description: This case was a middle-aged healthy and active woman that referred to our gynecology clinic due to menometrorrhagia and
dysmenorrhea. According to an ultrasound report, she had an enlarged myxomatosis uterus. Medical treatment did not work therefore she
chose the surgery. During surgery due to massive blood loss, 1 gram of tranexamic acid was infused two packed cells were transfused. After 48
hours of the surgery, the patient complained of shortness of breath. More evaluations showed PE. The patient had no thromboembolism risk
factors. It seemed that tranexamic acid caused thrombosis in this patient. After proper treatment measures such as anticoagulant medicines,
she was discharged from the hospital.
Clinical significance: Considering the risk of thrombosis in each case as prescribed tranexamic acid.
Keywords: Case report, Pulmonary embolism, Thromboembolism, Tranexamic acid.
World Journal of Laparoscopic Surgery (2023): 10.5005/jp-journals-10033-1549

bAckground 1,2,4–6 Department of Gynecology, Hoda International University, Iran

Pulmonary embolism (PE) which more commonly results from 3 Consultant Surgeon, World Laparoscopy Hospital, Gurugram,
deep vein thrombosis of the legs, might be asymptomatic, Haryana, India
diagnosed accidentally, or in some cases, it can lead to sudden Corresponding Author: Rajneesh Kumar Mishra, Consultant Surgeon,
1
death. It is a life-threatening condition and approximately World Laparoscopy Hospital, Gurugram, Haryana, India, Phone:
occurs 23 to 69 in 1,00,000 patients. Proper treatment measures +91 9938989938, e-mail: contact@laparoscopyhospital.com
2
are usually effective. Predisposing factors include coagulation How to cite this article: Ardabili SN, Zeinali A, Mishra RK, et al.
factors deficiency, sedentary lifestyle, hypercoagulation due to Pulmonary Thromboembolism While Receiving Tranexamic Acid
cancers, pregnancy, trauma, oral contraception pills, and major after Laparotomy Myomectomy: A Case Report. World J Lap Surg
1
surgeries. The homeostatic system helps the integration of blood 2023;16(1):52–53.
3
circulation following severe vascular damage through surgery. A Source of support: Nil
perturbation happens following major surgeries due to massive Conflict of interest: Dr Rajneesh Kumar Mishra is associated as Editor-
blood loss. A part of the body’s response in this condition is in-Chief of this journal and this manuscript was subjected to this
fibrinolysis, which can be pathologic in some cases and leads journal’s standard review procedures, with this peer review handled
3
to hyperfibrinolysis. Teranexamic acid is a fibrinolytic medicine independently of the Editor-in-Chief and his research group.
used mostly in major surgeries in order to prevent fibrinolysis and Patient consent statement: The author(s) have obtained written
reduce blood loss. informed consent from the patient for publication of the case report
details and related images.
cAse description
This case report is written to increase the healthcare providers’ in the anterior fundus. Both ovaries were reported with normal
awareness, which tranexamic acid can cause pulmonary appearance and no pelvic mass nor any fluid. The patient was
thromboembolism even in low-risk patients. healthy physically with BMI in the normal range, never smoked
This case is an Iranian 39 years old, nulligravida woman who cigarettes or drank alcohol, and had no previous history of deep
complained of menometrorrhagia and dysmenorrhea and was venous thrombosis (DVT) or PE. She also denied using any form of
referred to a gynecology clinic. The patient mentioned using contraceptive pills, had a recent long flight journey, and had no
Ferinject months ago and she had been using mefenamic acid and significant family history of clotting disorders or cancer. She only
Transid due to menorrhagia. The patient scored her dysmenorrhea mentioned that she is allergic to penicillin. She had no history of
7 out of 10 based on the pain scale. Her mensuration pattern was surgeries. She only mentioned hypothyroidism, which was under
9 days of menorrhagia and clot and 4 days of spotting. Based control, based on her laboratory result. The vital signs were in the
on an ultrasound report in 2021 she had multiple myomas in normal range. A day before the operation the patient’s laboratory
her uterus, which caused menometrorrhagia. Ultrasound report results included hemoglobin of 11 g/dL, and all coagulation factors
showed an enlarged uterus with intramural myomas 24 mm, were in normal range. The surgery was performed by an open
14 m, and a subserosal-intramural myoma sized 100 × 78 mm method and took an hour. The exact mass location under direct

© The Author(s). 2023 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.