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Pharm World Sci (2010) 32:416419 DOI 10.1007/s11096-010-9415-8
CASE REPORT
Hypersensitivity to tranexamic acid: a wide spectrum of adverse reactions
Selene Imbesi Eustachio Nettis Paola L. Minciullo
Elisabetta Di Leo Antonella Saija
Angelo Vacca Sebastiano Gangemi
Received: 27 February 2010 / Accepted: 28 June 2010 / Published online: 15 July 2010 Springer Science+Business Media B.V. 2010
Abstract Cases description This is a retrospective study, based on analysis of data from patients with previous adverse drug reactions admitted to the Allergy and Clinical Immunology Division of both the University of Messina and the University of Bari in the last 4 years. We observed ve patients: four of them (two males and two females) with a well documented history of tranexamic acid hypersensitivity reactions and one female who showed a positive response to an intradermal challenge test with tranexamic acid. Conclusions Although the risk of immunogenic and severe allergic reactions to tranexamic acid is signicantly lower than those associated with administration of other drugs, our experience points out that adverse reactions to tranexamic acid can occur. This drug may be responsible for a wide and various spectrum of hypersensitivity reactions characterized by different pathogenetic mechanisms (immunologic and non-immunologic). Etamsylate was a well tolerated alternative drug to tranexamic acid in all examined patients.
Keywords Adverse drug reaction Etamsylate
Hypersensitivity Tranexamic acid
Impact of ndings on practice
Tranexamic acid, although generally well tolerated, can cause hypersensitivity reactions through different mechanisms (immunological and non-immunological).
Although etamsylate can cause anaphylaxis and allergic reactions, it could represent an alternative antihemorrhagic drug with a different mechanism of action respect to tranexamic acid.
Introduction
A variety of drugs are available today to improve haemostasis and to reduce blood loss in multiple clinical syndromes: tranexamic acid, aprotinin, etamsylate (former Recommended International Non-proprietary Name, BAN: ethamsylate), vitamin K1, conjugated estrogens, desmopressin and recombinant coagulation products. Haemo-static agents can act through different mechanisms, by improving primary haemostasis, or stimulating thrombin generation and/or brin formation, or inhibiting brinolysis [1]. Tranexamic acid exerts its antibrinolytic effect through the reversible blockade of lysine binding sites on plasminogen molecules. It is used as rst line non-hormonal treatment of dysfunctional uterine bleeding, and of heavy bleeding associated with uterine broids, and it is also useful in the treatment of bleeding as a second...