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Tranexamic Acid引起癲癇之案例報告

Tranexamic Acid Induced Seizure: A Case Report

摘要


Tranexamic acid (Transamin^®) 為臨床上常用之止血劑。常見神經方面副作用為頭痛及偏頭痛;較少見的副作用如過敏、深層靜脈栓塞及癲癇之機率則小於1%。此案例報告為一位63 歲罹患膀胱癌合併慢性腎衰竭的病患,因排尿困難入院,且於治療期間疑似因腎功能不佳使用tranexamic acid 導致癲癇不良反應發生之個案。病患在使用tranexamic acid 四天後開始有不自主抽動,且於隔日中午發生僵直性癲癇症狀。經評估後停用tranexamic acid 改為aminocaproic acid, 並立即給予sodiumvalproate,病患症狀緩解且再無癲癇或不自主抽動狀況發生,並於停藥後第六日准予出院,其出院相關診斷為:seizure、suspect drug induced。藉由文獻回顧,本文探討此案例tranexamic acid induce seizure 之主要成因,乃由於其competitive GABA-A antagonist 之特性,除了高劑量下未依腎功能調整劑量之病人可能存在引發癲癇之風險已於臨床上廣為討論外,若併用因相同機轉而引發seizure 副作用的藥物(如本案例之cefazolin),亦同樣存在加乘作用的疑慮,故藉此個案可提醒臨床藥事執業者於藥事評估過程中,對於腎功能不佳的病人使用tranexamic acid 時,應多加注意是否有病史外或潛在藥物交互作用的風險,以避免造成病人發生不自主抽動及僵直相關不良反應之可能性。

並列摘要


Tranexamic acid (Transamin^®) is one of the most widely used antifibrinolytic agents in excessive bleeding treatment. Common neurological side effects are headache and migraine; deep vein thrombosis and allergies are less, and adverse reaction of epilepsy could be less than 1%. This case is a 63-year-old man with renal dysfunction, leading cases of seizure after administration of tranexamic acid for bleeding during hospitalization. On the fourth day of using tranexamic acid, patient started to involuntary convulsions; the next day occurred epilepsy at noon. After suspending the medication delivery and administered antiepileptic drugs, patient’s situation has improved and then discharged on the sixth day, diagnosis with seizure, suspect drug induced. According to our literature review, using high dose of tranexamic acid without any dose adjustment according to renal function may possibly cause seizure adverse reaction. Besides, seizure has also been notified when combining two different medications with the same mechanism. Therefore, such case reminds clinical professionals to be aware of unusual twitching or other signs of epilepsy related to impaired renal function or drug-drug interaction when using tranexamic acid.

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