Tranexamic acid induced seizure during spine surgery: A case report.

Introduction and importance: The management of perioperative blood loss is a significant concern in spine surgery, directly affecting patient recovery and outcomes. Tranexamic acid (TXA) is widely used to minimize intraoperative bleeding and reduce the need for transfusions. Despite its benefits, TXA can pose risks, including rare but severe complications such as seizures. Understanding the balance between its hemostatic advantages and potential adverse effects is critical. This case discusses a 66-year-old female who experienced a generalized tonic-clonic seizure after TXA administration during spine surgery. Presentation of case: A 66-year-old female with a history of hypertension, diabetes, depression, anxiety, and multiple spine surgeries presented with severe back and hip pain after a fall. She was found to have a fracture through her posterior fusion mass at L1-2. She underwent T10-L5 reinstrumentation, fusion, and L1-L2 laminectomy. She received a standard bolus of TXA and after being flipped supine developed a generalized tonic-clonic seizure which was controlled with propofol and versed. She experienced a subsequent seizure and PEA while in the CT suite, followed by successful resuscitation. She was discharged uneventfully to rehab with neurology follow up. Clinical discussion: TXA is effective in reducing surgical blood loss but can cause seizures by crossing the cerebrovascular barrier and antagonizing gamma-aminobutyric acid (GABA) receptors in the central nervous system (CNS). The incidence of TXA-induced seizures is rare, particularly in orthopedic surgery. Conclusion: Careful preoperative assessment and vigilant perioperative monitoring are essential when utilizing TXA in spine surgery. Increased awareness and prompt management of seizures can improve patient outcomes.