Dimitriadis F, Pitsolis T, Kolovou K, Maragoulia S, Theodorou E, Konstantinou G, Soulele T, Vlahodimitris I, Zervos M, Salata P, Elaiopoulos D, Gatzonis S, Dimopoulos S. Myoclonus associated with tranexamic acid administration in a patient on veno-arterial extracorporeal membrane oxygenation support: A case report. World J Crit Care Med 2026; 15(1): 115620 [DOI: 10.5492/wjccm.v15.i1.115620]
Corresponding Author of This Article
Stavros Dimopoulos, MD, PhD, Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 356 Syggrou Av, Athens 17674, Attikí, Greece. stdimop@gmail.com
Research Domain of This Article
Critical Care Medicine
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Case Report
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Mar 9, 2026 (publication date) through Mar 3, 2026
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Publication Name
World Journal of Critical Care Medicine
ISSN
2220-3141
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Dimitriadis F, Pitsolis T, Kolovou K, Maragoulia S, Theodorou E, Konstantinou G, Soulele T, Vlahodimitris I, Zervos M, Salata P, Elaiopoulos D, Gatzonis S, Dimopoulos S. Myoclonus associated with tranexamic acid administration in a patient on veno-arterial extracorporeal membrane oxygenation support: A case report. World J Crit Care Med 2026; 15(1): 115620 [DOI: 10.5492/wjccm.v15.i1.115620]
Fotios Dimitriadis, Theodoros Pitsolis, Kyriaki Kolovou, Sissy Maragoulia, Evangelia Theodorou, Giorgos Konstantinou, Theodora Soulele, Ioannis Vlahodimitris, Michail Zervos, Paraskevi Salata, Dimitrios Elaiopoulos, Stavros Dimopoulos, Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Attikí, Greece
Stergios Gatzonis, 1st Department of Neurosurgery, National & Kapodistrian University of Athens, Athens 17674, Attikí, Greece
Author contributions: Dimopoulos S conceptualized the study; Dimitriadis F and Dimopoulos S designed the methodology; Dimitriadis F, Dimopoulos S, and Gatzonis S validated the data; Maragoulia S, Konstantinou G, Soulele T, Vlahodimitris I, Pitsolis T, Kolovou K, Elaiopoulos D and Theodorou E performed the formal analysis, investigation and provided resources; Salata P and Zervos M curated the data; Dimitriadis F wrote the original draft; Dimitriadis F and Dimopoulos S reviewed and edited the manuscript; Dimopoulos S supervised the study and administered the project; all authors have read and approved the final version of the manuscript.
Informed consent statement: Written informed consent has been obtained from the patient to publish this paper.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this case report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Stavros Dimopoulos, MD, PhD, Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 356 Syggrou Av, Athens 17674, Attikí, Greece. stdimop@gmail.com
Received: October 21, 2025 Revised: December 10, 2025 Accepted: January 21, 2026 Published online: March 9, 2026 Processing time: 130 Days and 14.1 Hours
Abstract
BACKGROUND
Tranexamic acid (TXA) is widely used as an antifibrinolytic agent to reduce bleeding in cardiac and extracorporeal circulation settings. Neurological adverse effects, including seizures and myoclonus, are rare and not well documented in patients supported by extracorporeal membrane oxygenation (ECMO).
CASE SUMMARY
We report the case of a 52-year-old male with ST-elevation myocardial infarction and severe left ventricular dysfunction, who was transferred to our intensive care unit department under veno-arterial (VA)-ECMO support and continuous renal replacement therapy (CRRT). To maintain ECMO oxygenator function and due to decreasing fibrinogen levels, endovenous one gram TXA twice a day was administered and within hours after the second dose, the patient developed generalized myoclonic jerks. A non-contrast brain computed tomography revealed no acute or chronic abnormalities, and neurological evaluation attributed the findings to TXA as the most likely cause due to TXA overdose. Following discontinuation of TXA, the symptoms resolved within 48 hours.
CONCLUSION
This case highlights a rare neurological complication associated with TXA overdose, occurring in patient with VA-ECMO and CRRT. Clinicians should remain vigilant for such adverse effects in this context.
Core Tip: This article describes the first known case of tranexamic acid (TXA)-induced myoclonus in a patient receiving veno-arterial extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy. TXA accumulation due to impaired renal clearance led to neurotoxicity, which resolved after drug discontinuation. The case underscores the need for individualized TXA dosing and vigilant neurological monitoring in ECMO patients with renal dysfunction, given the absence of standardized dosing protocols and the delicate hemostatic balance in this setting.
