Thorac Cardiovasc Surg
DOI: 10.1055/s-0041-1724035
Original Cardiovascular

Moderate Dose of Tranexamic Acid and Complications after Valvular Heart Surgery

Nikolai Hulde
1  Institute of Anesthesiology and Pain Therapy, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
,
Armin Zittermann
2  Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
,
Marcus-Andre Deutsch
2  Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
,
Vera von Dossow
1  Institute of Anesthesiology and Pain Therapy, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
,
Jan E. Gummert
2  Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
,
Andreas Koster
1  Institute of Anesthesiology and Pain Therapy, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
› Author Affiliations
Funding None.

Abstract

Background In valvular open-heart surgery, data regarding the effect of a moderate dose of tranexamic acid (TXA) on clinical outcomes are limited.

Methods Out of a cohort of 13,293 patients, we performed a propensity-score-matched analysis in 6,106 patients and assessed the risk of convulsive seizures (CS, primary endpoint), stroke, renal replacement therapy, and mortality (secondary endpoints). In the entire study cohort of 13,293 patients, we also assessed the multivariable-adjusted association of CS with postoperative outcomes.

Results The risk of CS was significantly higher in the TXA group (2.4%; n = 72) than in the non-TXA group (1.0%; n = 32), with a relative risk ratio (RR) of 2.28 (95% confidence interval [CI]: 1.50–3.47; p < 0.001). The risk of CS was also higher in patients receiving TXA doses ≥25 mg/kg body weight (3.7%; n = 40) than in patients receiving <25 mg/kg body weight (1.6%; n = 32; p < 0.001). Perioperative secondary clinical endpoints and 1-year mortality did not differ significantly between study groups (p-value > 0.05). Compared with non-CS patients (n = 13,000), patients with nonhemorrhagic, nonembolic CS (n = 253) revealed higher multivariable-adjusted in-hospital risks of stroke (RR: 3.82 [95% CI: 2.44–5.60; p < 0.001]) and mortality (RR: 2.07 [95% CI: 1.23–3.48; p = 0.006]), and a higher 1-year mortality risk (RR: 1.85 [95% CI: 1.42–2.41; p < 0.001]).

Conclusion A moderate TXA dose was associated with a significantly higher risk of seizure, but not with other clinical complications such as stroke, renal replacement therapy, and mortality. However, in the small group of patients experiencing a seizure, the risks of stroke and short- and mid-term mortality were substantially higher than in patients not experiencing a seizure, indicating that the use of a low-dose TXA protocol (<25 mg/kg body weight) should be considered.

Data Repository

Hulde, Nikolai; Zittermann, Armin; Deutsch, Marcus-Andre; von Dossow, Vera; Gummert, Jan; Koster, Andreas (2020), “Tranexamic acid and convulsive seizure,” Mendeley Data, V1, doi: 10.17632/4679m73bb3.1; http://dx.doi.org/10.17632/4679m73bb3.1.


Supplementary Material



Publication History

Received: 12 October 2020

Accepted: 31 December 2020

Publication Date:
04 March 2021 (online)

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