myoclonus, seizure, and ventricular fibrillation after intrathecal injection of tranexamic acid

tranexamic acid is generally used in the treatment of disorders that predispose one to bleeding. it is a synthetic lysine analog that has strong antifibrinolytic activity. plasminogen binds to fibrin to form plasmin, which in turn degrades fibrin into fibrin degradation products. tranexamic acid blocks the lysine binding site on plasminogen and prevents interaction with fibrin. tranexamic acid reduces blood loss in open heart surgery, hip replacement, and gynecology procedures. in this first case of inadvertent intrathecal injection of tranexamic acid in a pregnant woman, we found that a massive intrathecal injection of tranexamic acid triggered refractory ventricular fibrillation and cardiovascular collapse, which did not respond to full resuscitation.