Case Report: Topical Tranexamic Acid as Novel Treatment of Refractory Bleeding After Excisional Cervical Procedure [27G]

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Abstract

INTRODUCTION:

Tranexamic acid (TXA) is a derivative of the amino acid lysine that inhibits fibrinolysis by blocking binding sites of plasminogen and preventing its conversion into plasmin. It is conventionally used intravenously or orally for management of bleeding related to menorrhagia, dental extraction, epistaxis or trauma. Topical use is well established in orthopedic and otolaryngologic surgery and has been described in cardiac and dental procedures. While intravenous use has been shown to reduce hemorrhage, the use of topical TXA treatment for cervical bleeding after excisional procedure has not been described.

METHODS:

A 37-year-old woman on lifelong anticoagulation due to a prosthetic mitral valve was followed for persistent cervical dysplasia progressing despite cryotherapy. She underwent an uncomplicated loop electrocautery excisional procedure (LEEP), however she suffered continued bleeding from the surgical site and failed management with repeat electrocautery, packing, sutures, and hemostatic agents. TXA solution was directly applied to the cervix daily as a bedside procedure for ten days.

RESULTS:

Topical application of TXA to the surgical site was ultimately successful in maintaining continued hemostasis.

CONCLUSION:

For a patient in whom systemic anticoagulation cannot be held obtaining continued hemostasis of mucosal bleeding sites can be difficult. Topical use of TXA should be considered as an option for treatment in patients with refractory bleeding from biopsy sites as its application is not difficult, is well tolerated, and appears to have minimal side effects. Further study is indicated to determine ideal treatment protocols.

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