Spontaneous Aortic Sealing with Tranexamic Acid in Type A Dissection: A Novel Life-Saving Finding.

Abstract

Aortic dissection is a life-threatening cardiovascular emergency, particularly Stanford type A, which typically necessitates urgent surgical intervention. Despite advances in surgical techniques and perioperative care, preoperative bleeding and coagulopathy remain significant challenges. Tranexamic acid, an antifibrinolytic agent, is widely used to minimize perioperative bleeding in cardiovascular surgeries; however, its role in the non-surgical, preoperative stabilization of aortic dissection has not been well established. We present the case of a 56-year-old woman with a history of hypertension and dyslipidaemia who presented with sudden-onset, severe interscapular chest pain. Computed tomography angiography revealed an ascending aortic dissection. Initial management included intravenous labetalol for blood pressure and heart rate control, along with the administration of 1 gram of tranexamic acid. She was subsequently transferred for emergent surgical repair. Intraoperatively, however, no active aortic bleeding was identified. Instead, a clot was found sealing the dissected segment of the ascending aorta, effectively halting further propagation and haemorrhage. This unexpected finding led to the cancellation of surgical repair. We hypothesize that tranexamic acid contributed significantly to the formation of this stabilizing clot through its antifibrinolytic effects. The patient's clinical outcome was favourable, with no complications observed. This case highlights a novel potential application of tranexamic acid in the emergency management of aortic dissection. To our knowledge, this is the first reported case in which tranexamic acid contributed to spontaneous thrombus formation within a dissected aortic segment, preventing catastrophic haemorrhage and obviating the need for surgery.

Learning points: This case highlights a potentially important role for tranexamic acid (TXA) in the management of aortic dissection. To our knowledge, this is the first reported case of its kind.While its established use in reducing postoperative bleeding and transfusion requirements is well documented, our case demonstrates a preoperative benefit, with TXA contributing to the formation of a stabilizing thrombus within the dissected aortic segment.This life-saving clot prevented further dissection and haemorrhage, ultimately deferring the need for surgical repair and reducing the risk of perioperative complications.We aim to underscore the need for further investigation into the potential role of tranexamic acid in the acute management of aortic dissection.