Al Hazzouri Antonio, Attieh Philippe, Karam Karam, Fiani Elias
Department of Internal medicine, University of Balamand, Beirut, Lebanon.
Department of Gastroenterology and Hepatology, University of Balamand, Beirut, Lebanon.
Eur J Case Rep Intern Med. 2025 Aug 18;12(9):005650. doi: 10.12890/2025_005650. eCollection 2025.
Aortic dissection is a life-threatening cardiovascular emergency, particularly Stanford type A, which typically necessitates urgent surgical intervention. Despite advances in surgical techniques and perioperative care, preoperative bleeding and coagulopathy remain significant challenges. Tranexamic acid, an antifibrinolytic agent, is widely used to minimize perioperative bleeding in cardiovascular surgeries; however, its role in the non-surgical, preoperative stabilization of aortic dissection has not been well established. We present the case of a 56-year-old woman with a history of hypertension and dyslipidaemia who presented with sudden-onset, severe interscapular chest pain. Computed tomography angiography revealed an ascending aortic dissection. Initial management included intravenous labetalol for blood pressure and heart rate control, along with the administration of 1 gram of tranexamic acid. She was subsequently transferred for emergent surgical repair. Intraoperatively, however, no active aortic bleeding was identified. Instead, a clot was found sealing the dissected segment of the ascending aorta, effectively halting further propagation and haemorrhage. This unexpected finding led to the cancellation of surgical repair. We hypothesize that tranexamic acid contributed significantly to the formation of this stabilizing clot through its antifibrinolytic effects. The patient's clinical outcome was favourable, with no complications observed. This case highlights a novel potential application of tranexamic acid in the emergency management of aortic dissection. To our knowledge, this is the first reported case in which tranexamic acid contributed to spontaneous thrombus formation within a dissected aortic segment, preventing catastrophic haemorrhage and obviating the need for surgery.
This case highlights a potentially important role for tranexamic acid (TXA) in the management of aortic dissection. To our knowledge, this is the first reported case of its kind.While its established use in reducing postoperative bleeding and transfusion requirements is well documented, our case demonstrates a preoperative benefit, with TXA contributing to the formation of a stabilizing thrombus within the dissected aortic segment.This life-saving clot prevented further dissection and haemorrhage, ultimately deferring the need for surgical repair and reducing the risk of perioperative complications.We aim to underscore the need for further investigation into the potential role of tranexamic acid in the acute management of aortic dissection.
主动脉夹层是一种危及生命的心血管急症，尤其是斯坦福A型，通常需要紧急手术干预。尽管手术技术和围手术期护理取得了进展，但术前出血和凝血功能障碍仍然是重大挑战。氨甲环酸是一种抗纤溶药物，广泛用于减少心血管手术中的围手术期出血；然而，其在主动脉夹层非手术、术前稳定中的作用尚未得到充分证实。我们报告一例56岁女性患者，有高血压和血脂异常病史，突发严重的肩胛间胸痛。计算机断层扫描血管造影显示升主动脉夹层。初始治疗包括静脉注射拉贝洛尔控制血压和心率，同时给予1克氨甲环酸。随后她被转至急诊进行手术修复。然而，术中未发现主动脉活动性出血。相反，发现一个血栓封闭了升主动脉的夹层段，有效阻止了进一步扩展和出血。这一意外发现导致手术修复取消。我们推测氨甲环酸通过其抗纤溶作用对这种稳定血栓的形成有显著贡献。患者临床结局良好，未观察到并发症。该病例突出了氨甲环酸在主动脉夹层急诊管理中的一种新的潜在应用。据我们所知，这是首例报道的氨甲环酸促成夹层主动脉段内自发血栓形成、预防灾难性出血并避免手术的病例。
本病例突出了氨甲环酸（TXA）在主动脉夹层管理中可能的重要作用。据我们所知，这是首例此类报道病例。虽然其在减少术后出血和输血需求方面的既定用途已有充分记录，但我们的病例显示了术前益处，TXA促成了夹层主动脉段内稳定血栓的形成。这个挽救生命的血栓阻止了进一步夹层和出血，最终推迟了手术修复的需要并降低了围手术期并发症的风险。我们旨在强调有必要进一步研究氨甲环酸在主动脉夹层急性管理中的潜在作用。
