Tranexamic Acid in Cardiac Surgery: A Case Report of an Infrequent Adverse Reaction to a Common Medication

Life-threatening anaphylaxis to tranexamic acid (TXA) is rare but critical in cardiac surgery. A 76-year-old patient undergoing elective ascending aorta replacement developed severe anaphylactic shock shortly after anesthesia induction. Subsequent skin prick tests confirmed a positive TXA reaction. While TXA and lysine derivatives were avoided in the second surgery, the patient experienced hyperfibrinolysis. Guided by rotational thromboelastometry, hemostatic therapy led to a successful outcome with minimal postoperative bleeding. This report emphasizes the importance of drug risk awareness and strategies to mitigate excessive bleeding in cardiac surgery.