{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:38:28Z","timestamp":1786649908103,"version":"build-2736575974"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Tranexamic acid (TXA) is commonly used in orthopedic surgery to reduce perioperative bleeding. Although generally safe, TXA has been associated with rare, but potentially life-threatening anaphylactic reactions. We report a case of severe anaphylaxis following intravenous TXA. A 33-year-old male with no known allergies developed severe bronchospasm, hypotension, ventricular arrhythmias, and lip swelling within min of TXA administration. Initial treatment included oxygen, intratracheal salbutamol, and intravenous pheniramine with delayed epinephrine due to the transient arrhythmias. Serum tryptase measured two hours later was within normal range. Six weeks postoperatively, skin prick test (SPT) showed trace positivity to TXA and a stepwise intravenous drug provocation test (DPT) reproduced clinical symptoms at 100 mg, confirming IgE-mediated hypersensitivity. This case highlights the diagnostic challenges of perioperative anaphylaxis under general anaesthesia and emphasizes the importance of early recognition, prompt epinephrine use, and confirmatory testing for safe perioperative management.<\/jats:p>","DOI":"10.4103\/sja.sja_646_25","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T07:01:01Z","timestamp":1767337261000},"page":"223-225","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Unexpected anaphylaxis to tranexamic acid confirmed by drug provocation testing in orthopedic surgery: A case report"],"prefix":"10.4103","volume":"20","author":[{"given":"Seung Eun","family":"Song","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ae-Ryoung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"R1-20260421","doi-asserted-by":"crossref","first-page":"e3054","DOI":"10.1136\/bmj.e3054","article-title":"Effect of tranexamic acid on surgical bleeding: Systematic review and cumulative meta-analysis","volume":"344","author":"Ker","year":"2012","journal-title":"BMJ"},{"key":"R2-20260421","doi-asserted-by":"crossref","first-page":"1416998","DOI":"10.3389\/fmed.2024.1416998","article-title":"Tranexamic acid: A narrative review of its current role in perioperative medicine and acute medical bleeding","volume":"11","author":"Bouras","year":"2024","journal-title":"Front Med 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life-threatening allergic reactions: Epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6)","volume":"121","author":"Harper","year":"2018","journal-title":"Br J Anaesth"},{"key":"R7-20260421","doi-asserted-by":"crossref","first-page":"216","DOI":"10.18176\/jiaci.0236","article-title":"Practical guidelines for perioperative hypersensitivity reactions","volume":"28","author":"Laguna","year":"2018","journal-title":"J Investig Allergol Clin Immunol"},{"key":"R8-20260421","doi-asserted-by":"crossref","first-page":"e20.00130","DOI":"10.2106\/JBJS.CC.20.00130","article-title":"Anaphylactic reaction to tranexamic acid during posterior spinal fusion: A case report","volume":"10","author":"Plaster","year":"2020","journal-title":"JBJS Case Connect"},{"key":"R9-20260421","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1111\/all.15996","article-title":"EAACI\/ENDA position paper on drug provocation testing","volume":"79","author":"Barbaud","year":"2024","journal-title":"Allergy"},{"key":"R10-20260421","doi-asserted-by":"crossref","first-page":"e50","DOI":"10.1016\/j.bja.2019.04.044","article-title":"Management of suspected immediate perioperative allergic reactions: An international overview and consensus recommendations","volume":"123","author":"Garvey","year":"2019","journal-title":"Br J Anaesth"}],"container-title":["Saudi Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.sja_646_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:59:47Z","timestamp":1786647587000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.sja_646_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/sja.sja_646_25","relation":{},"ISSN":["1658-354X","0975-3125"],"issn-type":[{"value":"1658-354X","type":"print"},{"value":"0975-3125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-08-11","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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