title: Seizures after open heart surgery: comparison of ε-aminocaproic acid and tranexamic acid.
abstract: OBJECTIVE
  Although the lysine analogs tranexamic acid (TXA) and aminocaproic acid (EACA) are used widely for antifibrinolytic therapy in cardiac surgery, relatively little research has been performed on their safety profiles, especially in the setting of cardiac surgery. Two antifibrinolytic protocols using either TXA or aminocaproic acid were compared according to postoperative outcome.
  
  
  METHODS
  A retrospective analysis.
  
  
  METHODS
  A university-affiliated hospital.
  
  
  METHODS
  Six hundred four patients undergoing cardiac surgery.
  
  
  METHODS
  One cohort of 275 consecutive patients received TXA; a second cohort of 329 consecutive patients was treated with EACA. Except for antifibrinolytic therapy, the anesthetic and surgical teams and their protocols remained unchanged.
  
  
  RESULTS
  Besides major outcome criteria, namely postoperative bleeding, the need for allogeneic transfusions, operative revision because of bleeding, postoperative renal dysfunction, neurologic events, heart failure, and in-hospital mortality, the authors specifically sought differences between the groups concerning seizures. The 2 cohorts were comparable over a range of perioperative factors. Postoperative seizures occurred significantly more frequently in TXA patients (7.6% v 3.3%, p = 0.019), whereas EACA patients had a higher incidence of postoperative renal dysfunction (20.0% v 30.1%, p = 0.005). There were no differences in all other measured major outcome factors.
  
  
  CONCLUSIONS
  Both lysine analogs are associated with significant side effects, which must be taken into account when performing risk-benefit analyses of their use. Their use should be restricted to patients at high risk for bleeding; routine use on low-risk patients undergoing standard surgeries should face renewed critical reappraisal.
authors.affiliation: Institute of Anaesthesiology, German Heart Center, Munich, Germany. martin@dhm.mhn.de
authors.forename: Klaus
authors.initials: K
authors.lastname: Martin
authors.forename: Jürgen
authors.initials: J
authors.lastname: Knorr
authors.forename: Tamás
authors.initials: T
authors.lastname: Breuer
authors.forename: Ralph
authors.initials: R
authors.lastname: Gertler
authors.forename: Martin
authors.initials: M
authors.lastname: Macguill
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
authors.forename: Peter
authors.initials: P
authors.lastname: Tassani
authors.forename: Gunther
authors.initials: G
authors.lastname: Wiesner
mesh_terms: D000368:Aged; D015119:Aminocaproic Acid / Q000009:adverse effects* / Q000627:therapeutic use; D000758:Anesthesia; D000933:Antifibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012640:Seizures / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology; D014148:Tranexamic Acid / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D015119:Aminocaproic Acid