Peritoneal dialysis catheter dysfunction due to fibrin clots following treatment with tranexamic acid: a clinical case
Chronic kidney disease patients experience not only more frequent arterial and venous thrombosis but also hemorrhagic episodes. Tranexamic acid is an anti-fibrinolytic molecule that inhibits plasmin activation. It is used in hemorrhage cases (post-traumatic, gynecologic, or gastrointestinal bleeding).
We report on an original case of tranexamic acid (Exacyl®) use in a peritoneal dialysis patient for gastrointestinal bleeding of unknown origin. The use of tranexamic acid led to the Tenckhoff catheter dysfunction because of fibrin clots in the dialysate.
The emergence of fibrin clots a few days after the start of tranexamic acid treatment, which never occurred again after the end of the treatment, and the anti-fibrinolytic function of tranexamic acid favors this treatment’s role in fibrin clot occurrence.
Bello, A. K. et al. Associations among estimated glomerular filtration rate, proteinuria, and adverse cardiovascular outcomes. Clin. J. Am. Soc. Nephrol. CJASN 6, 1418–1426 (2011).
Brantsma, A. H. et al. Cardiovascular and renal outcome in subjects with K/DOQI stage 1-3 chronic kidney disease: the importance of urinary albumin excretion. Nephrol. Dial. Transplant. Off. Publ. Eur. Dial. Transpl. Assoc. - Eur. Ren. Assoc. 23, 3851–3858 (2008).
Cheung, K. L. et al. Measures of Kidney Disease and the Risk of Venous Thromboembolism in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. Am. J. Kidney Dis. Off. J. Natl. Kidney Found. 70, 182–190 (2017).
Folsom, A. R. et al. Chronic kidney disease and venous thromboembolism: a prospective study. Nephrol. Dial. Transplant. Off. Publ. Eur. Dial. Transpl. Assoc. - Eur. Ren. Assoc. 25, 3296–3301 (2010).
Mahmoodi, B. K. et al. Association of mild to moderate chronic kidney disease with venous thromboembolism: pooled analysis of five prospective general population cohorts. Circulation 126, 1964–1971 (2012).
Wattanakit, K., Cushman, M., Stehman-Breen, C., Heckbert, S. R. & Folsom, A. R. Chronic kidney disease increases risk for venous thromboembolism. J. Am. Soc. Nephrol. JASN 19, 135–140 (2008).
Addi, T. et al. Mechanisms of tissue factor induction by the uremic toxin indole-3 acetic acid through aryl hydrocarbon receptor/nuclear factor-kappa B signaling pathway in human endothelial cells. Arch. Toxicol. 93, 121–136 (2019).
Addi, T., Dou, L. & Burtey, S. Tryptophan-Derived Uremic Toxins and Thrombosis in Chronic Kidney Disease. Toxins 10, (2018).
Pavord, S. & Myers, B. Bleeding and thrombotic complications of kidney disease. Blood Rev. 25, 271–278 (2011).
Murkin, J. M. et al. High-dose tranexamic Acid is associated with nonischemic clinical seizures in cardiac surgical patients. Anesth. Analg. 110, 350–353 (2010).
Jerath, A. et al. Tranexamic Acid Dosing for Cardiac Surgical Patients With Chronic Renal Dysfunction: A New Dosing Regimen. Anesth. Analg. 127, 1323–1332 (2018).
Bhat, A., Bhowmik, D. M., Vibha, D., Dogra, M. & Agarwal, S. K. Tranexamic acid overdosage-induced generalized seizure in renal failure. Saudi J. Kidney Dis. Transplant. Off. Publ. Saudi Cent. Organ Transplant. Saudi Arab. 25, 130–132 (2014).
Fuah, K. W., Lim, C. T. S., Pang, D. C. L. & Wong, J. S. Seizure induced by tranexamic acid in a patient with chronic kidney disease on maintenance dialysis. Saudi J. Kidney Dis. Transplant. Off. Publ. Saudi Cent. Organ Transplant. Saudi Arab. 29, 207–209 (2018).
Hunt, B. J. The current place of tranexamic acid in the management of bleeding. Anaesthesia 70, 50-e18 (2015).
Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. The Lancet 376, 23–32 (2010).
Ker, K., Edwards, P., Perel, P., Shakur, H. & Roberts, I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 344, e3054 (2012).
HALT-IT Trial Collaborators. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet Lond. Engl. 395, 1927–1936 (2020).
Suzuki, K. et al. Tranexamic acid: a ‘diuretic’ for the peritoneal membrane? Adv. Perit. Dial. Conf. Perit. Dial. 16, 42–45 (2000).
Kuriyama, S., Nakayama, M., Tomonari, H., Kawaguchi, Y. & Hosoya, T. Tranexamic acid increases peritoneal ultrafiltration volume in patients on CAPD. Perit. Dial. Int. J. Int. Soc. Perit. Dial. 19, 38–44 (1999).
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