Menorrhagia, Tranexamic Acid and False Negative D-Dimer in Patients with Venous Thromboembolism Case Report and Systematic Literature Review

A 56 years-old woman came to our attention for abrupt onset of shortness of breath. Pulmonary embolism was firstly ruled out due to negative D-Dimer and unlikely probability. On second day, the patient presented with heavy menorrhagia and treated with tranexamic acid (TA). She informed that similar episode happened some months ago, so she had been treated with cycles of TA, discontinued the last time few days before the hospital admission. After three days from oral intake of TA, the patient suffered from abrupt painful left calf without any cardiac or respiratory sign. Urgent legs ultrasonography showed distal deep vein thrombosis and this time a new D-Dimer assay showed a mild positivity. The patient underwent to computer tomography pulmonary angiography which revealed bilateral segmental pulmonary embolism. Other three case reports referred to patients with acute venous thromboembolism after taking TA for menorrhagia emerged from systematic review of literature. Two of them presented with false negative D-Dimer. In another one D-Dimer assay was positive but performed after cardiopulmonary resuscitation.
TA could link with venous thromboembolism both influencing D-Dimer value, proving false negativity, and increasing the thrombotic risk in young-adult females suffering from menorrhagia. These possibilities should be taken into account in this population.