Tranexamic acid and convulsive seizures after isolated coronary artery bypass surgery: The role of cardiopulmonary bypass and renal function

Abstract

In cardiac surgical patients, tranexamic acid (TXA) has been associated with an increased risk of convulsive seizure (CS). We aimed to investigate whether in patients undergoing isolated coronary artery bypass grafting (CABG) surgery the use of cardiopulmonary bypass (CPB) impacts the risk of CS. We studied 4198 propensity score matched patients. Patients who underwent CABG surgery without CPB, received a single bolus of 1 g TXA. Patients who underwent CABG with CPB, additionally received a TXA dose of 0.5 g in the CPB prime and an infusion of 0.2 g/h until the end of CPB. The risk of CS in the CPB group and the group without CPB was 0.7% and 0.6%, respectively (risk ratio 1.08, 95% confidence interval 0.51-2.30; P > 0.99). Kidney function was significantly associated with the risk of CS (P = 0.005), the latter being highest in patients with glomerular filtration rates <30 ml/min/1.73 m2 (2.2%) and lowest in those patients with values >60 ml/min/1.73 m2 (0.4%). Our data in patients undergoing isolated CABG indicate no significant effect on CS risk by use of CPB when TXA doses of up to ~2 g are given. However, caution regarding TXA administration is necessary in patients with renal impairment.