Seizures following cardiac surgery: the impact of tranexamic acid and other risk factors

• Published in: Canadian journal of anesthesia 2012-01, Vol.59 (1), p.6-13
• Main Authors: Manji, Rizwan A., Grocott, Hilary P., Leake, Jill, Ariano, Rob E., Manji, Jacqueline S., Menkis, Alan H., Jacobsohn, Eric
• Format: Article
• Language: English
• Subjects: Acids; Aged; Aged, 80 and over; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Anticonvulsants - therapeutic use; Antifibrinolytic Agents - administration & dosage; Antifibrinolytic Agents - adverse effects; Antifibrinolytic Agents - therapeutic use; Biological and medical sciences; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cardiology; Cohort Studies; Critical Care Medicine; Databases, Factual; Delirium; Dose-Response Relationship, Drug; Female; Heart surgery; Humans; Intensive; Intensive Care Units; Length of Stay; Logistic Models; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Mortality; Multivariate Analysis; Neurosurgery; Pain Medicine; Pediatrics; Physiology; Pneumology/Respiratory System; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Regression analysis; Reports of Original Investigations; Risk Factors; Seizures - drug therapy; Seizures - epidemiology; Seizures - etiology; Stroke; Tranexamic Acid - administration & dosage; Tranexamic Acid - adverse effects; Tranexamic Acid - therapeutic use
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-011-9618-z

Background Seizures after cardiac surgery are a serious complication. The antifibrinolytic agent tranexamic acid (TA), which has known proconvulsant properties, may be associated with postoperative seizures. We sought to determine the association between TA and other risk factors for seizures after cardiac surgery. Methods and results We analyzed a database of consecutive cardiac surgery patients (April 2003 to December 2009) using multivariable logistic regression analysis to assess for seizure risk factors. Seizures occurred in 56 of 5,958 patients (0.94%). TA use was associated with an increased risk of seizures (odds ratio 7.4, 95% confidence interval 2.8–19.3; P   20; preoperative cardiac arrest; preoperative neurological disease; open chamber surgery; cardiopulmonary bypass time > 150 min; and previous cardiac surgery. Seizures occurred at a median of 5.3 hr (interquartile range 2.4–15.1 hr) after the end of surgery. In all, 58.1% were grand mal, 14.5% were associated with a stroke, and 58.1% recurred in hospital. Altogether, 48.3% of the patients were able to discontinue anticonvulsant medications prior to discharge. Compared to the non-seizure group, seizure patients had an increased rate of postoperative neurological complications, defined as delirium and/or stroke (3.2% vs 19.6%, P