Microscopic haematuria as a relative contraindication for tranexamic acid

Area of Science:

• Hematology
• Nephrology
• Urology

Background:

• Tranexamic acid is used for bleeding disorders like thrombocytopenia.
• Macroscopic hematuria is a known contraindication for tranexamic acid.
• Platelet transfusions may be ineffective in some severe bleeding cases.

Observation:

• Three patients with microscopic hematuria experienced urinary tract clot formation.
• These patients were treated with tranexamic acid for bleeding tendencies.
• The clot formation occurred despite the absence of macroscopic hematuria.

Findings:

• Microscopic hematuria, previously considered safe, led to adverse clot formation.
• Tranexamic acid's pro-coagulant effects manifested as urinary tract clots in these cases.
• This highlights a previously unrecognized risk associated with tranexamic acid use.

Implications:

• Microscopic hematuria should be considered a contraindication for tranexamic acid.
• Clinicians should carefully assess urinary status before prescribing tranexamic acid.
• Further research is needed to understand the mechanism of clot formation in microscopic hematuria.