title: High-dose tranexamic acid is an independent predictor of early seizure after cardiopulmonary bypass.
abstract: BACKGROUND
  Risk factors associated with early seizure after cardiopulmonary bypass (CPB) were examined. The role of tranexamic acid in seizure development was evaluated.
  
  
  METHODS
  Early seizure was defined as a seizure occurring within 24 hours of CPB, without neurologic deficit or new lesion on brain imaging. Independent determinants of early seizure were examined by multivariate logistic regression modelling.
  
  
  RESULTS
  Between 2004 and 2009, early seizure occurred in 119 of 8,929 patients (1.3%). A significant increase in the yearly rate of early seizure was observed in 2004 (0.73%) vs 2009 (1.97%; p<0.0001). Multivariate analysis showed the following variables were independent predictors of early seizure: age older than 75 years (adjusted odds ratio [OR], 2.1; p=0.0001), open heart procedure (OR, 12.0; p<0.0001), preoperative renal failure (OR, 3.2; p<0.0001), peripheral vascular disease (OR, 1.8; p=0.02), and total tranexamic acid dose of 100 mg/kg or more (OR, 2.6; p<0.0001). Risk of seizure was related to tranexamic acid in a dose-dependent fashion, with higher doses associated with increased risk of seizure. The use of CO2 in a subset of patients undergoing open heart procedures did not decrease the incidence of early seizure (4.8% vs 2.5% for no CO2; p=0.27). Postoperative chest tube drainage and blood product use were similar between patients receiving low-dose and high-dose tranexamic acid.
  
  
  CONCLUSIONS
  High-dose tranexamic acid (≥100 mg/kg) is independently associated with an increased risk of early seizure. Future tranexamic acid trials should assess the blood-conserving effect of tranexamic acid at a lower dosage and specifically monitor for seizure occurrence.
authors: Department of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Dimitri
authors: D
authors: Kalavrouziotis
authors: Pierre
authors: P
authors: Voisine
authors: Siamak
authors: S
authors: Mohammadi
authors: Stephanie
authors: S
authors: Dionne
authors: Francois
authors: F
authors: Dagenais
mesh_terms: D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007432:Intraoperative Period; D008279:Magnetic Resonance Imaging; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications; D011379:Prognosis; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014148:Tranexamic Acid / Q000008:administration & dosage*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid