Abstract 18007: Seizures Following Cardiac Surgery: The Impact of Tranexamic Acid and Other Risk Factors
Background: Seizures (SZ) after cardiac surgery (CS) is a potentially serious complication. Recently, tranexamic acid (TA), which has proconvulsant properties, has been implicated in postoperative SZ. We sought to determine the association of TA and other risk factors for postoperative SZ in CS patients.
Methods: A prospectively collected database of all consecutive patients having CS from Apr 2003 – Jan 2010 was analyzed. Multivariate logistic regression analysis was used to determine the risk factors for SZ.
Results: SZ occurred in 56/5958 patients (incidence = 0.94%). TA became the sole antifibrinolytic used in 2007 after which the SZ rate increased 8 fold (0.19% pre- vs. 1.54% post-TA, p<0.001). Patients who had SZ received on average 81 mg/kg of TA vs. 64 mg/kg in patients that did not have SZ (p<0.001). The univariate and multivariate analysis for SZ are outlined in the table. In SZ patients (compared to non-SZ patients), the postoperative neurologic complication (delirium/confusion and stroke) rate (19.6% vs. 3.2%, p<0.001), ICU length of stay (4.7 days vs. 1.0 day, p < 0.001) and ICU mortality (7.1 % vs. 1.4 %, p = 0.001) were higher.
Conclusions: Our data suggest that multiple risk factors (preoperative morbidities, open heart procedures with inherent risks of cerebral embolization, and TA with its proconvulsant effects) may be associated with postoperative SZ. The impact of TA on seizures warrants further prospective study.
- © 2010 by American Heart Association, Inc.