Cerebral infarction after late tranexamic acid administration in severe trauma: a case report

Abstract

Tranexamic acid (TXA) reduces mortality associated with traumatic bleeding when administered early, with the greatest benefit within the first 3 hours. We report a previously healthy 23-year-old woman with severe shotgun trauma and persistent bleeding who received TXA approximately 20 hours after injury (1 g intravenously over 10 minutes followed by 1 g over 8 hours). The following day, she developed progressive neurological deterioration and a large left middle cerebral artery territory infarction with mass effect, requiring decompressive craniectomy. Subsequent evaluation did not identify a rheumatologic, hematologic, or cardiac prothrombotic condition. The patient improved and was discharged from hospital 60 days after admission. This case highlights the need to carefully assess the indication and timing of TXA in trauma settings with delayed access to definitive care.