Moderate dosage of tranexamic acid during cardiac surgery with cardiopulmonary bypass and convulsive seizures: incidence and clinical outcome

Br J Anaesth. 2013 Jan;110(1):34-40. doi: 10.1093/bja/aes310. Epub 2012 Sep 17.

Abstract

Background: Convulsive seizures (CS) occur in ∼1% of the patients after cardiac surgery with cardiopulmonary bypass. Recent investigations indicate an up to seven-fold increase in CS in cardiac surgical patients receiving high doses (≥60 mg kg(-1) body weight) of tranexamic acid (TA).

Methods: In a retrospective data analysis of 4883 cardiac surgical patients, we investigated the incidence of CS in patients receiving a moderate dose of TA (24 mg kg(-1) body weight) compared with a reference group not receiving TA as a primary endpoint. Secondary endpoints were intensive care unit stay and in-hospital mortality. We performed propensity score (PS)-adjusted logistic regression analysis to test the association between TA use/non-use and clinical outcomes.

Results: Compared with the reference group, the PS-adjusted odds ratio (OR) for CS in the TA group was 1.703 [95% confidence interval (CI): 1.01-2.87; P=0.045; incidence 2.5% vs 1.2%]. Log-ICU-stay was significantly longer (P=0.004) and PS-adjusted relative in-hospital mortality risk was significantly higher for the TA group compared with the reference group (OR=1.89; 95% CI: 1.21-2.96; P=0.005). Both the TA-associated CS incidence and the in-hospital mortality risk were only significant in patients undergoing open-heart surgery (OR=2.034, 95% CI: 1.07-3.87; P=0.034 and OR=2.20, 95% CI: 1.32-3.69; P=0.003, respectively) but not in patients undergoing coronary artery bypass grafting (OR=1.21, 95% CI: 0.49-3.03; P=0.678 and OR=1.13, 95% CI: 0.42-3.02; P=0.809, respectively).

Conclusions: In open-heart surgery, even moderate TA doses are associated with a doubled rate of CS and in-hospital mortality. Prospective trials are needed to further evaluate the safety profile of TA in cardiac surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthesia
  • Antifibrinolytic Agents / administration & dosage
  • Antifibrinolytic Agents / adverse effects*
  • Antifibrinolytic Agents / therapeutic use*
  • Cardiac Surgical Procedures / methods*
  • Cardiac Surgical Procedures / mortality
  • Cardiopulmonary Bypass / methods*
  • Cardiopulmonary Bypass / mortality
  • Cohort Studies
  • Coronary Artery Bypass
  • Creatinine / blood
  • Endpoint Determination
  • Female
  • Glomerular Filtration Rate
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Seizures / chemically induced
  • Seizures / epidemiology*
  • Tranexamic Acid / administration & dosage
  • Tranexamic Acid / adverse effects*
  • Tranexamic Acid / therapeutic use*
  • Treatment Outcome
  • Vasoconstrictor Agents / therapeutic use
  • Young Adult

Substances

  • Antifibrinolytic Agents
  • Vasoconstrictor Agents
  • Tranexamic Acid
  • Creatinine