title: Pharmacokinetics of tranexamic acid in patients undergoing cardiac surgery with use of cardiopulmonary bypass.
abstract: We conducted a study to assess pharmacokinetics of high-dose tranexamic acid for 24 h after administration of the drug in patients undergoing cardiac surgery with cardiopulmonary bypass. High-dose tranexamic acid involved a bolus of 30 mg.kg(-1) infused over 15 min followed by a 16 mg.kg(-1) .h(-1) infusion until chest closure with a 2 mg.kg(-1) load within the pump prime. Tranexamic acid followed first-order kinetics best described using a two-compartment model, with a total body clearance that approximated the glomerular filtration rate. Mean plasma tranexamic acid concentrations during the intra-operative period and in the first 6 postoperative hours were consistently higher than the suggested threshold to achieve 100% inhibition and 80% inhibition of tissue plasminogen activator. With recent studies implicating high-dose tranexamic acid as a possible aetiology of postoperative seizures following cardiac surgery, the minimum effective yet safe dose of tranexamic acid in high-risk cardiac surgery needs to be refined.
authors: Department of Surgery, University of Toronto and Division of Cardiac Surgery, Toronto General Hospital, Toronto, Canada. drvvs@rediffmail.com
authors: V
authors: V
authors: Sharma
authors: J
authors: J
authors: Fan
authors: A
authors: A
authors: Jerath
authors: K S
authors: KS
authors: Pang
authors: B
authors: B
authors: Bojko
authors: J
authors: J
authors: Pawliszyn
authors: J M
authors: JM
authors: Karski
authors: T
authors: T
authors: Yau
authors: S
authors: S
authors: McCluskey
authors: M
authors: M
authors: Wąsowicz
mesh_terms: D000368:Aged; D000465:Algorithms; D000758:Anesthesia; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D014018:Tissue Distribution; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000493:pharmacokinetics*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid