Tranexamic Acid (TXA)
- Initially, one thousand milligrams of TXA were diluted into one hundred milliliters of normal saline and used to soak a four by four-inch piece of gauze. The gauze was wrapped around the tongue and pressure was applied by the patient for approximately ten minutes.
- Although bleeding slowed, there continued to be oozing from the left aspect of the tongue.
- A left lingular nerve block was performed using 3 milliliters of lidocaine with epinephrine. After appropriate anesthesia of the tongue, silver nitrate was applied generously to the left aspect of the bifurcated tongue until hemostasis was obtained.
TXA ultimately prevents fibrin degradation, which is a key component in clotting. A synthetic derivative of lysine, TXA can reversibly and competitively inhibit the lysine receptor found on plasminogen. Plasminogen is thereby unable to be activated into plasmin (which usually degrades fibrin), leading to inhibition of fibrinolysis. TXA has been well documented in the literature to treat a number of bleeding conditions including hemoptysis, gastrointestinal (GI) bleeding, and vaginal bleeding [1, 2].
Silver nitrate, an inorganic chemical cautery agent, induces formation of an eschar from the binding of free silver ions to tissue. The eschar obstructs small blood vessels, resulting in hemostasis. Silver nitrate is applied topically to the bleeding area to form an eschar .