Tranexamic acid is widely used as an antifibrinolytic agent in different conditions including menstrual bleeding, trauma, dental procedures etc. though considered safe, its use on a long term basis in an abnormal dose is not without adverse effects. Both arterial and venous thrombosis in different vascular beds has been described with its use. Here in, we report a rare case of bilateral acute lower limb arterial thrombosis in a young female who had used tranexamic acid inadvertently for a long period of time. Our patient presented with sudden onset of weakness of both lower limbs and progressively worsening blackish discoloration ascending from foot to mid leg. Her evaluation revealed bilateral common femoral and superficial femoral arterial occlusion on CT angiogram, moderate renal insufficiency, and evidence of rhabdomyolysis. Her procoagulant screening and connective tissue disease profile were negative. She has been managed with anticoagulation as per hospital protocol and also been given antiplatelets. She progressed to bilateral lower limb gangrene for which fore quarter amputation was done. It is advisable to exercise caution in using long term tranexamic acid usage especially in people who have thombophilic tendencies.

Keywords: Tranexamic Acid; Arterial Thrombosis.