Abstract 13710: Recurrent Seizures Following Cardiac Surgery - Risk Factors and Outcomes
Introduction: Risk factors for recurrent seizures following cardiac surgery, as well as outcomes of these patients is not well studied. Tranexamic acid (TA), a renally cleared anti-fibrinolytic agent which has proconvulsant properties, has been implicated in seizures post cardiac surgery.
Objective: To determine the risk factors associated with recurrent seizures following cardiac surgery as well as ICU outcomes of these patients.
Methods: All cardiac surgery patients experiencing seizures post-operatively from April 2003 until September 2010 were analyzed and divided into those with recurrent seizure and those without. Multivariable logistic regression analysis was used to determine risk factors associated with recurrent seizure.
Results: There were 62 patients experiencing seizures following cardiac surgery, and 36 (58.1%) experienced a recurrent seizure during hospital stay, with 32 (89%) having their recurrent seizure within 24 hours of the first seizure. Statistically and clinically relevant differences between the groups included (see table): pre-operative creatinine level, APACHE II score, open chamber procedure, thoracic aortic surgery, induced hypothermic circulatory arrest intra-operatively, post-operative stroke, and time from end surgery to first seizure. TA dosing was statistically similar between the groups. Multivariate logistic regression revealed that pre-operative creatinine ≥120 umol/L (OR 11.3; 95% CI 1.6 - 81.8, p=0.02), and time from end surgery to first seizure ≤ 4 hours (OR 11.0; 95% CI 1.9 - 65.5, p=0.01) were significantly associated with recurrent seizure.
Conclusion: Our study suggests that patients with first seizure within 4 hours of end of surgery and patients with renal dysfunction (with possibly higher circulating blood levels of TA due to decreased renal clearance) have an increased risk of recurrent seizure. Patients with recurrent seizure have an increased length of stay in the ICU.
- © 2011 by American Heart Association, Inc.