Moderate dosage of tranexamic acid during cardiac surgery with cardiopulmonary bypass and convulsive seizures: incidence and clinical outcome

Convulsive seizures (CS) occur in approximate to 1 of the patients after cardiac surgery with cardiopulmonary bypass. Recent investigations indicate an up to seven-fold increase in CS in cardiac surgical patients receiving high doses (epsilon 60 mg kg(1) body weight) of tranexamic acid (TA). In a retrospective data analysis of 4883 cardiac surgical patients, we investigated the incidence of CS in patients receiving a moderate dose of TA (24 mg kg(1) body weight) compared with a reference group not receiving TA as a primary endpoint. Secondary endpoints were intensive care unit stay and in-hospital mortality. We performed propensity score (PS)-adjusted logistic regression analysis to test the association between TA use/non-use and clinical outcomes. Compared with the reference group, the PS-adjusted odds ratio (OR) for CS in the TA group was 1.703 [95 confidence interval (CI): 1.012.87; P0.045; incidence 2.5 vs 1.2]. Log-ICU-stay was significantly longer (P0.004) and PS-adjusted relative in-hospital mortality risk was significantly higher for the TA group compared with the reference group (OR1.89; 95 CI: 1.212.96; P0.005). Both the TA-associated CS incidence and the in-hospital mortality risk were only significant in patients undergoing open-heart surgery (OR2.034, 95 CI: 1.073.87; P0.034 and OR2.20, 95 CI: 1.323.69; P0.003, respectively) but not in patients undergoing coronary artery bypass grafting (OR1.21, 95 CI: 0.493.03; P0.678 and OR1.13, 95 CI: 0.423.02; P0.809, respectively). In open-heart surgery, even moderate TA doses are associated with a doubled rate of CS and in-hospital mortality. Prospective trials are needed to further evaluate the safety profile of TA in cardiac surgery.