title: The great deception: tranexamic acid and extensive pulmonary emboli.
abstract: Pulmonary embolism (PE) is a common and life-threatening condition. The British Thoracic Society PE guidelines state that PE is reliably excluded in patients with low-intermediate clinical probability and a negative D-dimer. We are reporting the case of a 47-year-old lady, taking tranexamic acid for menorrhagia, who presented with shortness of breath and was diagnosed with extensive bilateral PE. She had a low clinical risk of PE as determined by her Wells score, and a subsequent negative D-dimer. This patient's D-dimer value of 15 ng/ml (HemosIL DD HS assay) was the lowest associated with any CT pulmonary angiogram (n=1645) recorded at our trust over a 2-year period. This lady was successfully treated with a heparin infusion and warfarin. No further thromboembolic events had occurred by 18-month follow-up. To our knowledge, this is the first case report to describe tranexamic acid causing an extremely low false-negative D-dimer masking PE.
authors: Department of Respiratory Medicine, Central Middlesex Hospital, North West London Hospitals NHS Trust, London, UK. amrsalam@nhs.net
authors: Amr
authors: A
authors: Salam
authors: Christopher
authors: C
authors: King
authors: Orhan
authors: O
authors: Orhan
authors: Vincent
authors: V
authors: Mak
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D005188:False Negative Reactions; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D008595:Menorrhagia / Q000188:drug therapy; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014148:Tranexamic Acid / Q000009:adverse effects* / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D014859:Warfarin; D014148:Tranexamic Acid; D006493:Heparin
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