PMID- 22065333
OWN - NLM
STAT- MEDLINE
DCOM- 20120425
LR  - 20131121
IS  - 1496-8975 (Electronic)
IS  - 0832-610X (Linking)
VI  - 59
IP  - 1
DP  - 2012 Jan
TI  - Seizures following cardiac surgery: the impact of tranexamic acid and other risk 
      factors.
PG  - 6-13
LID - 10.1007/s12630-011-9618-z [doi]
AB  - 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 < 0.001). 
      Multivariable logistic regression analysis revealed that the following factors 
      were significantly associated with seizures: TA exposure; Acute Physiology, Age, 
      and Chronic Health Evaluation (APACHE) II score > 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 < 0.001), 
      increased intensive care unit (ICU) length of stay (1.0 vs 4.7 days, P < 0.001), 
      and increased ICU mortality (1.4 % vs 9.7 %, P = 0.001). CONCLUSIONS: Our data 
      suggest that multiple risk factors, including TA, are associated with seizures 
      after cardiac surgery. Thus, the TA dose may be a readily modifiable risk factor 
      for postoperative seizures.
FAU - Manji, Rizwan A
AU  - Manji RA
AD  - Department of Surgery, University of Manitoba, Winnipeg, MB, Canada. 
      rmanji@sbgh.mb.ca
FAU - Grocott, Hilary P
AU  - Grocott HP
FAU - Leake, Jill
AU  - Leake J
FAU - Ariano, Rob E
AU  - Ariano RE
FAU - Manji, Jacqueline S
AU  - Manji JS
FAU - Menkis, Alan H
AU  - Menkis AH
FAU - Jacobsohn, Eric
AU  - Jacobsohn E
LA  - eng
PT  - Journal Article
DEP - 20111108
PL  - United States
TA  - Can J Anaesth
JT  - Canadian journal of anaesthesia = Journal canadien d'anesthesie
JID - 8701709
RN  - 0 (Anticonvulsants)
RN  - 0 (Antifibrinolytic Agents)
RN  - 6T84R30KC1 (Tranexamic Acid)
SB  - IM
CIN - Can J Anaesth. 2012 Jan;59(1):1-5. PMID: 22052288
CIN - Can J Anaesth. 2013 May;60(5):506-7. PMID: 23435664
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticonvulsants/therapeutic use
MH  - Antifibrinolytic Agents/administration & dosage/adverse effects/therapeutic use
MH  - Cardiac Surgical Procedures/*adverse effects/methods
MH  - Cohort Studies
MH  - Databases, Factual
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Humans
MH  - Intensive Care Units
MH  - Length of Stay
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Postoperative Complications/epidemiology/*etiology
MH  - Risk Factors
MH  - Seizures/drug therapy/epidemiology/*etiology
MH  - Tranexamic Acid/administration & dosage/*adverse effects/therapeutic use
EDAT- 2011/11/09 06:00
MHDA- 2012/04/26 06:00
CRDT- 2011/11/09 06:00
PHST- 2011/02/10 00:00 [received]
PHST- 2011/10/19 00:00 [accepted]
PHST- 2011/11/09 06:00 [entrez]
PHST- 2011/11/09 06:00 [pubmed]
PHST- 2012/04/26 06:00 [medline]
AID - 10.1007/s12630-011-9618-z [doi]
PST - ppublish
SO  - Can J Anaesth. 2012 Jan;59(1):6-13. doi: 10.1007/s12630-011-9618-z. Epub 2011 Nov 
      8.