High-dose tranexamic acid is related to increased risk of generalized seizures after aortic valve replacement

European Journal of Cardio-thoracic Surgery

Volumn 39, Issue 5, 2011, Pages

  Keyl, Cornelius ^a   Uhl, Reiner ^a   Beyersdorf, Friedhelm ^b   Stampf, Susanne ^b   Lehane, Cornelius ^a   Wiesenack, Christoph ^c   Trenk, Dietmar ^a  

^a UNIVERSITY HEART CENTER FREIBURG BAD KROZINGEN   (Germany)

^b UNIVERSITY OF FREIBURG   (Germany)

^c Marienhospital Gelsenkirchen ^*  (Germany)

Author keywords

Antifibrinolytic agent; Aortic valve replacement; Seizure; Tranexamic acid

Indexed keywords

AMINOCAPROIC ACID; BLOOD CLOTTING FACTOR 7A; CREATININE; RECOMBINANT ENZYME; TRANEXAMIC ACID;

ADULT; AGED; AORTA VALVE REPLACEMENT; ARTICLE; CONTROLLED STUDY; CORONARY ARTERY BYPASS SURGERY; CREATININE CLEARANCE; DISEASE ASSOCIATION; DRUG MEGADOSE; EXTRACORPOREAL CIRCULATION; FEMALE; GRAND MAL SEIZURE; HUMAN; HUMAN CELL; LOADING DRUG DOSE; LOGISTIC REGRESSION ANALYSIS; MAJOR CLINICAL STUDY; MALE; MORBIDITY; PEROPERATIVE CARE; POSTOPERATIVE CARE; POSTOPERATIVE PERIOD; PRIORITY JOURNAL; RETROSPECTIVE STUDY;

6-AMINOCAPROIC ACID; AGED; AGED, 80 AND OVER; ANTIFIBRINOLYTIC AGENTS; AORTIC VALVE; DRUG ADMINISTRATION SCHEDULE; FEMALE; HEART VALVE PROSTHESIS IMPLANTATION; HUMANS; INTRAOPERATIVE CARE; MALE; MIDDLE AGED; POSTOPERATIVE HEMORRHAGE; RETROSPECTIVE STUDIES; SEIZURES; TRANEXAMIC ACID;

EID: 79954600429     PISSN: 10107940     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.ejcts.2010.12.030     Document Type: Article

References (25)

1. Fergusson D.A., Hebert P.C., Mazer C.D., Fremes S., MacAdams C., Murkin J.M., Teoh K., Duke P.C., Arellano R., Blajchman M.A., Bussieres J.S., Cote D., Karski J., Martineau R., Robblee J.A., Rodger M., Wells G., Clinch J., Pretorius R. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med 2008, 358:2319-2331.
2. Later A.F., Maas J.J., Engbers F.H., Versteegh M.I., Bruggemans E.F., Dion R.A., Klautz R.J. Tranexamic acid and aprotinin in low- and intermediate-risk cardiac surgery: a non-sponsored, double-blind, randomised, placebo-controlled trial. Eur J Cardiothorac Surg 2009, 36:322-329.
3. Schneeweiss S., Seeger J.D., Landon J., Walker A.M. Aprotinin during coronary-artery bypass grafting and risk of death. N Engl J Med 2008, 358:771-783.
4. Jakobsen C.J., Sondergaard F., Hjortdal V.E., Johnsen S.P. Use of aprotinin in cardiac surgery: effectiveness and safety in a population-based study. Eur J Cardiothorac Surg 2009, 36:863-868.
5. Stamou S.C., Reames M.K., Skipper E., Stiegel R.M., Nussbaum M., Geller R., Robicsek F., Lobdell K.W. Aprotinin in cardiac surgery patients: is the risk worth the benefit?. Eur J Cardiothorac Surg 2009, 36:869-875.
6. Brown J.R., Birkmeyer N.J., O'Connor G.T. Meta-analysis comparing the effectiveness and adverse outcomes of antifibrinolytic agents in cardiac surgery. Circulation 2007, 115:2801-2813.
7. Martin K., Wiesner G., Breuer T., Lange R., Tassani P. The risks of aprotinin and tranexamic acid in cardiac surgery: a one-year follow-up of 1188 consecutive patients. Anesth Analg 2008, 107:1783-1790.
8. Murkin J.M., Falter F., Granton J., Young B., Burt C., Chu M. High-dose tranexamic acid is associated with nonischemic clinical seizures in cardiac surgical patients. Anesth Analg 2009, 110:350-353.
9. Sander M., Spies C.D., Martiny V., Rosenthal C., Wernecke K.D., von Heymann C. Mortality associated with administration of high-dose tranexamic acid and aprotinin in primary open-heart procedures: a retrospective analysis. Crit Care 2010, 14:R148.
10. Karski J.M., Dowd N.P., Joiner R., Carroll J., Peniston C., Bailey K., Glynn M.F., Teasdale S.J., Cheng D.C. The effect of three different doses of tranexamic acid on blood loss after cardiac surgery with mild systemic hypothermia (32 degrees C). J Cardiothorac Vasc Anesth 1998, 12:642-646.
11. Butterworth J., James R.L., Lin Y., Prielipp R.C., Hudspeth A.S. Pharmacokinetics of epsilon-aminocaproic acid in patients undergoing aortocoronary bypass surgery. Anesthesiology 1999, 90:1624-1635.
12. Katz M.H. Multivariable analysis. A practical guide for clinicians 2006, Cambridge University Press, Cambridge.
13. Fodstad H. Convulsive seizures following subdural application of fibrin sealant containing tranexamic acid in a rat model. Neurosurgery 2001, 49:479-480.
14. Furtmuller R., Schlag M.G., Berger M., Hopf R., Huck S., Sieghart W., Redl H. Tranexamic acid, a widely used antifibrinolytic agent, causes convulsions by a gamma-aminobutyric acid(A) receptor antagonistic effect. J Pharmacol Exp Ther 2002, 301:168-173.
15. Walder B., Tramer M.R., Seeck M. Seizure-like phenomena and propofol: a systematic review. Neurology 2002, 58:1327-1332.
16. Rabinovici R., Heyman A., Kluger Y., Shinar E. Convulsions induced by aminocaproic acid infusion. DICP 1989, 23:780-781.
17. Pilbrant A., Schannong M., Vessman J. Pharmacokinetics and bioavailability of tranexamic acid. Eur J Clin Pharmacol 1981, 20:65-72.
18. Andersson L., Eriksson O., Hedlund P.O., Kjellman H., Lindqvist B. Special considerations with regard to the dosage of tranexamic acid in patients with chronic renal diseases. Urol Res 1978, 6:83-88.
19. Fiechtner B.K., Nuttall G.A., Johnson M.E., Dong Y., Sujirattanawimol N., Oliver W.C., Sarpal R.S., Oyen L.J., Ereth M.H. Plasma tranexamic acid concentrations during cardiopulmonary bypass. Anesth Analg 2001, 92:1131-1136.
20. Wolman R.L., Nussmeier N.A., Aggarwal A., Kanchuger M.S., Roach G.W., Newman M.F., Mangano C.M., Marschall K.E., Ley C., Boisvert D.M., Ozanne G.M., Herskowitz A., Graham S.H., Mangano D.T. Cerebral injury after cardiac surgery: identification of a group at extraordinary risk. Multicenter Study of Perioperative Ischemia Research Group (McSPI) and the Ischemia Research Education Foundation (IREF) Investigators. Stroke 1999, 30:514-522.
21. Thomas G.O., Dutton R.P., Hemlock B., Stein D.M., Hyder M., Shere-Wolfe R., Hess J.R., Scalea T.M. Thromboembolic complications associated with factor VIIa administration. J Trauma 2007, 62:564-569.
22. Gill R., Herbertson M., Vuylsteke A., Olsen P.S., von Heymann C., Mythen M., Sellke F., Booth F., Schmidt T.A. Safety and efficacy of recombinant activated factor VII: a randomized placebo-controlled trial in the setting of bleeding after cardiac surgery. Circulation 2009, 120:21-27.
23. Verstraete M. Clinical application of inhibitors of fibrinolysis. Drugs 1985, 29:236-261.
24. Henry D., Carless P., Fergusson D., Laupacis A. The safety of aprotinin and lysine-derived antifibrinolytic drugs in cardiac surgery: a meta-analysis. CMAJ 2009, 180:183-193.
25. Casati V., Guzzon D., Oppizzi M., Cossolini M., Torri G., Calori G., Alfieri O. Hemostatic effects of aprotinin, tranexamic acid and epsilon-aminocaproic acid in primary cardiac surgery. Ann Thorac Surg 1999, 68:2252-2256. [discussion 2256-7].