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Polymyoclonus, ventricular fibrillation and Takotsubo after accidental spinal injection of tranexamic acid
  1. Laura Costa,
  2. Marina Costa,
  3. José Martins and
  4. Rui Castro
  1. Intensive Care Medicine, Hospital of Braga, Braga, Portugal
  1. Correspondence to Dr Laura Costa; laura.a.costa{at}


Several factors have been identified as contributing to medication administration errors, including look-alike, sound-alike (LASA) errors. LASA errors are important causes of serious adverse events arising from spinal injection of tranexamic acid, which can be confused with ampoules of local anaesthesia.

We present a case of accidental injection of 250 mg of tranexamic acid rather than prilocaine during spinal anaesthesia. The patient developed lower extremities myoclonus, followed by generalised convulsions and ventricular fibrillation, that was reverted within 6 min. Severe cardiogenic shock requiring both inotropic and vasopressor therapy followed, along with a classic apical ballooning pattern on echocardiography and elevated myocardial injury markers, indicating Takotsubo cardiomyopathy. The patient’s condition progressively improved to full recovery, and she was discharged from hospital after 1 month with no neurological deficit or cardiac dysfunction.

To our knowledge, this is the 28th reported case of accidental spinal injection of tranexamic acid. We present a brief review of previously published cases.

  • Anaesthesia
  • Drugs and medicines
  • Neurology (drugs and medicines)
  • Epilepsy and seizures
  • Healthcare improvement and patient safety

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  • Contributors LC was responsible for conceptualisation (idea; formulation and evolution of investigation aims) and oversaw overall direction and planning. LC, MC and JM were responsible for drafting of the text, acquisition, analysis and interpretation of clinical data and document structuring and writing. MC and JM were responsible for investigation and analysis of results (ECG, biochemical and ultrasound imaging) and document writing. JM and RC were responsible for sourcing and editing the clinical images and supplemental material. LC and RC were responsible for content revision and document editing. All authors discussed the results and commented on the manuscript. All authors participated in the critical revision for important intellectual content and gave their final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.