Generalized Tonic-clonic Seizure Caused by Tranexamic Acid Administration in Spinal Surgery: A Case Report and Literature Review

INTRODUCTION: Tranexamic acid, an antifibrinolytic solvent, has been widely used for perioperative hemostasis in orthopedic surgery. However, to the best of our knowledge, there have been no reports in the literature of seizures caused by tranexamic acid administration for orthopedic surgery. This report presents a case of generalized tonic-clonic seizure caused by tranexamic acid administration immediately after lumbar interbody fusion surgery for lumbar spinal canal stenosis. CASE REPORT: A 66-year-old Japanese woman scheduled for lumbar interbody fusion surgery was administered an intravenous pre-operative dose (1000 mg) of tranexamic acid and 2000 mg immediately after the surgery. Generalized convulsive seizures occurred on awakening from anesthesia. Although the seizures disappeared after deepening the anesthesia, they recurred on awakening, and extubation could not be performed. A computed tomography scan was immediately performed, revealing an intracranial lesion, but there were no other obvious abnormal findings. The patient was then managed in the intensive care unit, and several convulsions occurred on the 2nd post-operative day. The convulsions disappeared on the 3rd post-operative day, and the patient has had no sequelae to date. CONCLUSION: This original case report will be of interest to orthopedic surgeons, anesthesiologists, neurologists, and pharmacologists. The information presented may also have a broader impact in the field of medicine for other types of surgeons. The details provided in the report will advance knowledge in the area of orthopedic surgery, neurology, pharmacology, and anesthesiology. Orthopedic surgeons should be aware that one of the major complications of tranexamic acid administration is seizure liability.