氨甲环酸相关的急性心肌梗死：已发表病例回顾

doi:10.24920/003596

摘要/Abstract

摘要：

目的总结已发表的氨甲环酸（TXA）相关的急性心肌梗死（AMI）病例。
方法我们在电子数据库中检索已发表的TXA治疗后的AMI病例,并分别提取入选病例的相关数据,包括患者AMI的临床表现、辅助检查、药物治疗史、AMI治疗结果及预后。
结果最终检索出7篇已发表的TXA治疗后的AMI病例报道（共7例患者）,其中2篇来自美国,其余5篇分别来自印度、土耳其、英国、意大利和法国。7例患者中,年龄最轻者28岁,最长者77岁,5例为女性,2例为男性。4人接受TXA治疗系因外科出血、2例因月经出血、1例因咯血。7例患者AMI的诊断基于症状、ECG表现、心肌酶及冠状动脉造影。4例患者在确诊后接受了冠状动脉支架植入术、抗血小板及抗凝治疗等。在住院及随访期内,无死亡病例,7例均未发生其他重大的心血管事件。
结论本文提示TXA与AMI可能相关。即便是栓塞低风险的患者,这种风险也值得重视。

关键词: 氨甲环酸, 血栓形成, 心肌梗死

Abstract:

Objective To summarize cases of acute myocardial infarction (AMI) after tranexamic acid (TXA) administration.
Methods Electronic databases were searched to identify all case reports presenting AMI after use of TXA. Two authors independently extracted data of patients’ manifestation, examinations, medical history, treatment and outcome.
Results Our search yielded seven case reports including seven patients. Among the seven reports, two were from USA, and the other five were from India, Turkey, UK, Italy and France, respectively. Of the seven patients aged between 28- and 77-year-old who developed AMI after TXA, five patients were female and two were male. TXA was prescribed for four patients to reduce surgical bleeding, for two patients to treat menorrhagia and for one patient to manage hemoptysis. The diagnosis of AMI was made based upon patients’ symptoms, ECG, myocardium-specific enzymes, and confirmed by coronary angiography. Coronary stents were placed in four patients, for whom anti-platelet and anti-coagulation drugs were prescribed. No death or major cardiovascular events were reported during hospitalization and follow-up.
Conclusion These case reports suggested a possible association of TXA administration and an increased risk of AMI, even in patients with relatively low thrombotic risk.

Key words: tranexamic acid, thrombosis, myocardial infarction

Yao Yuntai, Yuan Xin, Shao Ken. Acute Myocardial Infarction After Tranexamic Acid: Review of Published Case Reports[J].Chinese Medical Sciences Journal, 2020, 35(1): 65-70.

图/表 3

Search strategies	Results
MEDLINE (“tranexamic acid”[MeSH Terms] OR (“tranexamic”[All Fields] AND “acid”[All Fields]) OR “tranexamic acid”[All Fields]) AND ((“myocardial ischaemia”[All Fields] OR “myocardial ischemia”[MeSH Terms] OR (“myocardial”[All Fields] AND “ischemia”[All Fields]) OR “myocardial ischemia”[All Fields] OR “coronary artery disease”[MeSH Terms] OR (“coronary”[All Fields] AND “artery”[All Fields] AND “disease”[All Fields]) OR “coronary artery disease”[All Fields] OR (“myocardial”[All Fields] AND “ischemia”[All Fields])) OR (“myocardial infarction”[MeSH Terms] OR (“myocardial”[All Fields] AND “infarction”[All Fields]) OR “myocardial infarction”[All Fields]) OR ((“myocardium”[MeSH Terms] OR “myocardium”[All Fields] OR “myocardial”[All Fields]) AND (“wounds and injuries”[MeSH Terms] OR (“wounds”[All Fields] AND “injuries”[All Fields]) OR “wounds and injuries”[All Fields] OR “injury”[All Fields])) OR (“troponin”[MeSH Terms] OR “troponin”[All Fields]) OR (“creatine kinase”[MeSH Terms] OR (“creatine”[All Fields] AND “kinase”[All Fields]) OR “creatine kinase”[All Fields]) OR (“l-lactate dehydrogenase”[MeSH Terms] OR (“l-lactate”[All Fields] AND “dehydrogenase”[All Fields]) OR “l-lactate dehydrogenase”[All Fields] OR (“lactate”[All Fields] AND “dehydrogenase”[All Fields]) OR “lactate dehydrogenase”[All Fields]) OR (“electrocardiography”[MeSH Terms] OR “electrocardiography”[All Fields] OR “electrocardiograph”[All Fields])) AND (“humans”[MeSH Terms] AND English[lang])	7/120
OVID ((Tranexamic acid AND myocardial ischemia).mp.[mp=ti, ab, tx, kw, ct, ot, sh, hw]) OR ((Tranexamic acid AND myocardial infarction).mp.[mp=ti, ab, tx, kw, ct, ot, sh, hw]) OR ((Tranexamic acid AND myocardial injury).mp.[mp=ti, ab, tx, kw, ct, ot, sh, hw]) OR ((Tranexamic acid AND troponin).mp.[mp=ti, ab, tx, kw, ct, ot, sh, hw]) OR ((Tranexamic acid AND creatine kinase).mp.[mp=ti, ab, tx, kw, ct, ot, sh, hw]) OR ((Tranexamic acid AND lactate dehydrogenase).mp.[mp=ti, ab, tx, kw, ct, ot, sh, hw]) OR ((Tranexamic acid AND Electrocardiograph.mp.[mp=ti, ab, tx, kw, ct, ot, sh, hw])	0/100
Cochrane ((“Tranexamic acid”):ti, ab, kw (Word variations have been searched) AND ((“myocardial ischemia”): ti, ab, kw (Word variations have been searched) OR (“myocardial infarction”): ti, ab, kw (Word variations have been searched) OR (“myocardial injury”): ti, ab, kw (Word variations have been searched) OR (“troponin”): ti, ab, kw (Word variations have been searched) OR (“creatine kinase”): ti, ab, kw (Word variations have been searched) OR (“lactate dehydrogenase”): ti, ab, kw (Word variations have been searched) OR (“Electrocardiograph”): ti, ab, kw (Word variations have been searched))	0/123

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References	Country	Sex	Age (yrs)	Risk factors of thrombosis	Past history	TXA and co-medications
Gerstein et al.^[10]	USA	M	66	deep vein thrombosis, transit ischemia attack, HIV(+)	COPD, spine surgeries	TXA (1 g iv. followed by 1 mg/kg·h infusion) during spine surgery
Garg et al.^[9]	USA	F	56	hypertension, obesity, smoking	arthritis	TXA (10 mg/kg iv.) before hip anthroplasty
Gupta et al.^[11]	India	F	41	hypertension	menorrhagia, dysmenorrhoea, uterus fibroid	TXA (0.5 g po tid ×2 year)+mefenamic acid (0.25 g po tid ×2 year) for menorrhagia and dysmenorrhoea
Günaldi et al.^[12]	Turkey	M	49	hemophilia A, factor V Leiden mutation, smoking	intra-articular hemorrhage	TXA (20 mg/kg po. qd ×10 days) and r-FⅧ (40 U/kg iv.) before tooth extraction
Sirker et al.^[13]	UK	F	28	hyperlipidemia, contraceptive	bleeding diathesis, nose bleeding	TXA (1 g qd ×1 week) and DDAVP iv. after and before shoulder surgery, respectively
Iacobellis et al.^[14]	Italy	F	42	contraceptive	uterine leiomyoma	TXA (3 g im. qd) and contraceptive pill (ethinylestradiol 20 μg and gestodene 75 μg) ×2 months for menorrhagia
Mekontso-Dessap et al.^[15]	France	F	77	hypertension	tuberculosis	TXA (0.5 g po. bid ×5 day then 1.0 g po bid ×2 days) for haemoptysis related to pulmonary tuberculosis

References	Onset	Manifestations	ECG	Enzymes	CA angiography	Diagnosis
Gerstein et al.^[10]	in PACU	tachycardia	ST elevation (anterior, anterolateral leads)	TnI 4.04 ng/ml	proximal LAD lesion, complete occlusion of diagonal branch	MI, LV thrombus
Garg et al.^[9]	postoperatively	chest pain, diaphoresis, hypotension	ST elevation (leads Ⅱ, Ⅲ, aVF)	TnI 0.25 ng/ml and CK 427 U/L	complete occlusion of the distal RCA	MI (inferior wall)
Gupta et al.^[11]	fourteen days from last time of TXA	chest pain, sweating	ST elevation (inferior wall and RV)	Not reported	RCA: eccentric 99% lesion of proximal RCA with thrombus	MI (inferior wall, RV)
Günaldi et al.^[12]	after r-FⅧ administration	chest pain, agitation, sweating	ST elevation (leads Ⅲ, Ⅱ, aVF, V4) and ST depression (leads V1, V2)	LDH 392U/L and CK-MB 170 U/L	RCA 90% stenosis, LAD 40% stenosis	MI (inferoposterolateral wall, RV)
Sirker et al.^[13]	three days after therapy	chest pain	ST elevation (inferior)	elevated in keeping with the acute occlusion	Occlusion in a small distal branch of RCA, minimal wall irregularity of LAD	MI (inferior wall)
Iacobellis et al.^[14]	two months after TXA and contraceptive	chest pain	deep negative T waves and Q wave in leads V1 to V4	TnI 4.3 μg/ml, CK-MB 66 ng/ml, and CK 653 U/L	Ulcerated plaque on proximal LAD without narrowing	MI
Mekontso-Dessap et al.^[15]	two days after dosage doubling	chest pain	ECG resolved quickly	TnI 5 μg/ml	Middle portion of LAD focal stenosis 30%	MI

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