Tranexamic Acid in cardiac surgery and postoperative seizures: a case report series.
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.
Bell
David
D
Department of Surgery, Monash University, Melbourne, Australia.
Marasco
Silvana
S
Almeida
Aubrey
A
Rowland
Michael
M
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*
D000933:Antifibrinolytic Agents; D010656:Phenylephrine; D014148:Tranexamic Acid