title: Tranexamic Acid in cardiac surgery and postoperative seizures: a case report series.
abstract: With the recent withdrawal of the antifibrinolytic aprotinin from the market, tranexamic acid (TxA) has become more widely used. This change has led to increasing concern about the side-effect profile of TxA, particularly the incidence of postoperative seizures. In this case series, we describe 7 patients over an 18-month period who had open-chamber cardiac surgery and developed seizures in the postoperative period. This incidence is increased compared with that of a cohort of patients in the previous 36 months who did not receive TxA (0.66% versus 0%; P < .05). The exact mechanism of TxA-induced seizures is thought to be via inhibition of gamma-aminobutyric acid receptors in neurons. Data from the neurosurgical literature show a well-established link between this antifibrinolytic and seizures. There is now increasing awareness of this association in cardiac surgery, particularly when high TxA doses are used.
authors: Department of Surgery, Monash University, Melbourne, Australia.
authors: David
authors: D
authors: Bell
authors: Silvana
authors: S
authors: Marasco
authors: Aubrey
authors: A
authors: Almeida
authors: Michael
authors: M
authors: Rowland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D008297:Male; D010656:Phenylephrine / Q000008:administration & dosage / Q000009:adverse effects; D011183:Postoperative Complications / Q000401:mortality; D012131:Respiratory Insufficiency / Q000209:etiology; D012640:Seizures / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology; D012770:Shock, Cardiogenic / Q000139:chemically induced; D014148:Tranexamic Acid / Q000009:adverse effects*
chemical_list: D000933:Antifibrinolytic Agents; D010656:Phenylephrine; D014148:Tranexamic Acid