Authors: Isaac Ihinmikaye, Emmanuel Temitope Taiwo, Adebimpe Funmilola Ogunmodede, and Olufemi Oladele
Ayodeji

CITATION: Isaac Ihinmikaye, Emmanuel Temitope Taiwo, Adebimpe Funmilola Ogunmodede, and Olufemi Oladele Ayodeji (2026). Hemostatic outcomes of tranexamic acid use in severe Lassa fever-associated hematuria: Evidence from a multi-patient case analysis in South Western Nigeria. Frontline Professionals Journal 3(1), 10-18

ABSTRACT

Lassa fever remains a major public health challenge in West Africa and is frequently complicated by coagulopathy and hemorrhagic manifestations, including severe hematuria. While ribavirin is the mainstay of treatment, evidence guiding adjunctive hemostatic therapy is limited. Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated benefit in trauma and surgical bleeding, but its role in viral hemorrhagic fevers is not well established. This analysis documents hemostatic outcomes following the use of tranexamic acid in patients with PCR-confirmed Lassa fever presenting with severe hematuria in a tertiary treatment center in Southwestern Nigeria. A multi-patient case analysis was conducted involving three adults with confirmed Lassa fever who developed gross hematuria and bleeding diathesis. All patients received standard ribavirin therapy and supportive care. Intravenous TXA (500 mg every 8 hours) was administered alongside vitamin K. Clinical progression, daily laboratory parameters, resolution time of hematuria, and adverse events were assessed. All three patients exhibited classical features of severe Lassa fever, including thrombocytopenia, elevated liver enzymes, anemia, and gross hematuria. Following TXA administration, hematuria began to improve within 48–72 hours and resolved completely between days 4 and 6 of therapy. Coagulation profiles and hematologic parameters stabilized progressively. No thromboembolic or other TXA-related complications were observed. Patients completed ribavirin therapy and were discharged with full clinical recovery. Adjunctive use of tranexamic acid was associated with rapid improvement of severe hematuria and favorable hemostatic outcomes in this multi-patient case analysis. Although causality cannot be inferred from the small sample size, the consistent clinical response suggests that TXA may offer beneficial hemostatic support in selected cases of Lassa fever–associated bleeding. Larger prospective studies are required to establish safety, efficacy, and optimal treatment protocols.