{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T12:44:52Z","timestamp":1792759492079,"version":"4.5.0"},"reference-count":18,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,3,8]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:p>Tranexamic acid (TXA) is an antifibrinolytic which minimises bleeding and transfusions, with thrombotic risk. Our patient had known coronary artery disease with post-TXA acute ST-elevation myocardial infarction (STEMI) due to in-stent thrombosis. He had five drug-eluting stents (DES): two overlapping DES in mid-LAD (3 years ago), and two overlapping DES in distal right coronary artery and one DES in obtuse-marginal (1.5 years ago). After TXA, both overlapping stent locations thrombosed. Of nine reports of post-TXA acute MI, only one had complex stent anatomy (bifurcation stent to left circumflex\/first obtuse-marginal) with other single stents, and only the complex stent thrombosed. Post-TXA MI was more often STEMI caused by arterial thrombosis, rather than non-STEMI caused by blood loss, hypotension or demand ischaemia. Overlapping and bifurcation stents thrombosed; single stents remained patent. In conclusion, overlapping stents, bifurcation stents, excessive stent length and previous in-stent restenosis\/thrombosis may increase thrombotic risk. TXA should be administered cautiously with complex stent anatomy.<\/jats:p>","DOI":"10.1136\/bcr-2018-227957","type":"journal-article","created":{"date-parts":[[2019,4,8]],"date-time":"2019-04-08T12:46:36Z","timestamp":1554727596000},"page":"e227957","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Acute ST-elevation myocardial infarction due to in-stent thrombosis after administering tranexamic acid in a high cardiac risk patient"],"prefix":"10.1136","volume":"12","author":[{"given":"Yvonne E","family":"Kaptein","sequence":"first","affiliation":[{"name":"Internal Medicine, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,4,8]]},"reference":[{"key":"2025082709091205000_12.4.e227957.1","doi-asserted-by":"crossref","first-page":"3065","DOI":"10.1016\/j.arth.2018.08.002","article-title":"Tranexamic Acid Use in Total Joint Arthroplasty: The Clinical Practice Guidelines Endorsed by the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society","volume":"33","author":"Fillingham","year":"2018","journal-title":"J Arthroplasty"},{"key":"2025082709091205000_12.4.e227957.2","doi-asserted-by":"crossref","first-page":"e221","DOI":"10.1097\/MJT.0b013e31828fdb06","article-title":"ST elevation myocardial infarction after tranexamic acid: first reported case in the United States","volume":"21","author":"Garg","year":"2014","journal-title":"Am J Ther"},{"key":"2025082709091205000_12.4.e227957.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1606424"},{"key":"2025082709091205000_12.4.e227957.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g4829"},{"key":"2025082709091205000_12.4.e227957.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2013.05.026"},{"key":"2025082709091205000_12.4.e227957.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e3054"},{"key":"2025082709091205000_12.4.e227957.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60835-5"},{"key":"2025082709091205000_12.4.e227957.8","doi-asserted-by":"publisher","DOI":"10.1023\/B:CARD.0000033646.21346.e4"},{"key":"2025082709091205000_12.4.e227957.9","doi-asserted-by":"crossref","first-page":"e77","DOI":"10.1016\/j.spinee.2015.10.039","article-title":"Left ventricle thrombus after tranexamic acid for spine surgery in an HIV-positive patient","volume":"16","author":"Gerstein","year":"2016","journal-title":"Spine J"},{"key":"2025082709091205000_12.4.e227957.10","doi-asserted-by":"crossref","unstructured":"Gupta PN , Mullamalla UR , Sabin P , et al . 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