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Revista Médica del Uruguay

versão impressa ISSN 0303-3295versão On-line ISSN 1688-0390

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AYALA, Santiago. Inadverted intrathecal injection of tranexamic acid. Rev. Méd. Urug. [online]. 2021, vol.37, n.1, e401.  Epub 01-Mar-2021. ISSN 0303-3295.  https://doi.org/10.29193/rmu.37.1.7.

A descriptive review of tranexamic acid injection in the subarachnoid space is performed. A point is made that this error may have catastrophic consequences on the patient with a high percentage of mortality. Possible causes that can lead to an erroneous injection are analyzed. A warning is made about tranexamic acid preparations being similar in appearance to those of bupivacaine for intrathecal use. The study describes the clinical manifestation of this complication, the toxicity mechanism, treatments used, and the evolution of the cases reported in the references found.

Strategies to avoid complications are discussed, pointing out that safety should not be based on human perfection, but on measures that make it difficult for humans to make mistakes.

Palavras-chave : Tranexamic acid; Intrathecal injection.

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