Seizures following cardiac surgery: the impact of tranexamic acid and other risk factors

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• 作者：Rizwan A. Manji MD ; PhD (1) (2) (5)
  Hilary P. Grocott MD (3)
  Jill Leake CRA (2)
  Rob E. Ariano PharmD (4)
  Jacqueline S. Manji PhD (2)
  Alan H. Menkis MD (1) (2)
  Eric Jacobsohn MBChB (3)
  
• 刊名：Canadian Journal of Anesthesia/Journal canadien d'anesth篓娄sie
• 出版年：2012
• 出版时间：January 2012
• 年：2012
• 卷：59
• 期：1
• 页码：6-13
• 全文大小：310KB
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• 作者单位：Rizwan A. Manji MD, PhD (1) (2) (5)
  Hilary P. Grocott MD (3)
  Jill Leake CRA (2)
  Rob E. Ariano PharmD (4)
  Jacqueline S. Manji PhD (2)
  Alan H. Menkis MD (1) (2)
  Eric Jacobsohn MBChB (3)
  
  1. Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
  2. Cardiac Sciences Program, Winnipeg Regional Health Authority, St. Boniface Hospital, Winnipeg, MB, Canada
  5. I.H. Asper Clinical Research Institute, St. Boniface Hospital, CR3014 -369 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada
  3. Department of Anaesthesia, University of Manitoba, Winnipeg, MB, Canada
  4. Department of Pharmacy, St. Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
  

文摘

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 2.8-9.3; 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 2.4-5.1 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.