National Alert Network: Tranexamic Acid – Local Anesthetic Administration Errors Resulting in Seizures & Prevention Recommendations

September 9, 2020

The National Alert Network (NAN) describes three cases of accidental administration of intrathecal tranexamic acid instead of local anesthetics, resulting in seizures. The top caps of vials for tranexamic acid and many local anesthetics have a similar or equal blue color (see Figure).

The Institute for Safe Medication Practices (ISMP) published an article in early May 2020 describing concerns of accidental tranexamic administration, linked below.

Full Article PDF: HERE

May 23rd 2020 ISMP Article: Dangerous Wrong-Route Errors with Tranexamic Acid—A Major Cause for Concern

Accidental Administration of Intrathecal Tranexamic Acid Causes Seizures