Low Dose Versus High Dose Tranexamic Acid Reduces the Risk of Non-Ischemic Seizures after Cardiac Surgery with Cardiopulmonary Bypass

• Published in: Journal of cardiothoracic and vascular anesthesia
• Main Authors: Couture, Pierre, MD, Lebon, Jean-Sébastien, MD, Laliberté, Éric, Desjardins, Georges, MD, Chamberland, Marie-Ève, MD, Ayoub, Christian, MD, Rochon, Antoine, MD, Cogan, Jennifer, MD, Denault, André, MD, PhD, Deschamps, Alain, MD, PhD
• Format: Journal Article
• Language: English
• Published: 2017
• Subjects: Anesthesia & Perioperative Care; Critical Care; antifibrinolytics; Tranexamic acid; seizures; cardiac surgery; open heart surgery
• ISSN: 1053-0770
• DOI: 10.1053/j.jvca.2017.04.026

Objective We evaluated the incidence of post-operative non-ischemic seizures associated with the use of tranexamic acid (TXA) and the possibility of prevention with a low dose regimen of TXA. Design Retrospective study. Setting Tertiary care university hospital. Participants A total of 12195 patients undergoing cardiac surgical procedures under cardiopulmonary bypass were evaluated. Interventions We revised the files of every clinical seizure case diagnosed in the surgical intensive care unit (SICU) between April 2006 and April 2014. Patients experiencing post-operative seizure undergo a cerebral CT-scan to exclude ischemic lesion. Dosage and type of antifibrinolytic used as well as surgery characteristics were retrieved from perfusion files. Low dose TXA was defined as follows: 1000mg bolus, 400mg /h perfusion and 500 mg in CPB priming and high dose: 30mg/kg bolus, 15mg/kg/h and 2mg/kg in CPB priming. Results No seizure was observed in the 886 patients who did not received antifibrinolytics. A total of 98 clinical seizures (0.8%) were recorded in the ICU and ischemic cause was excluded after reviewing CT-scan results in the majority of them (91 patients (93 %)). Low dose TXA was associated with less seizures than the high dose TXA (46/7452 cases (0.70%), 34/2190 cases (1.55%) P <0.0001). Open chamber cardiac surgery was also linked to a higher incidence of seizures when compared with revascularization (80/6662 (1.20%) and 11/5533 (0.20%), p  <0.0001). Conclusions Lower doses of TXA were associated with a reduction in the incidence of non-ischemic seizures when compared to higher doses.