• Nikolai Hulde, Armin Zittermann, Marcus-Andre Deutsch, von DossowVeraVInstitute of Anesthesiology and Pain Therapy, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bochum, Germany., Jan F Gummert, and Andreas Koster.
• Institute of Anesthesiology and Pain Therapy, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bochum, Germany.
• Interact Cardiovasc Thorac Surg. 2019 Dec 1; 29 (6): 852-854.

AbstractThere is evidence that, in adult cardiac surgical patients undergoing on-pump procedures, tranexamic acid (TXA) dose-dependently increases the risk of convulsive seizure (CS). We aimed to investigate whether a single TXA bolus of 1 g influences the risk of CS in patients who were operated on without the use of cardiopulmonary bypass. In 2249 propensity-score-matched pairs who underwent off-pump coronary artery bypass grafting with or without TXA administration, the risk of CS was 0.5% and 0.3% in the TXA and non-TXA groups, respectively (P = 0.36). In the subgroups of patients with estimated glomerular filtration rates <30, 30-60 and >60 ml/min/1.73 m2, the risk of CS in the TXA group was 2.8%, 1.2% and 0.4%, respectively (P = 0.002), and in the non-TXA group 0.0%, 0.0% and 0.3%, respectively (P = 0.36). The risk of stroke, in-hospital mortality and 30-day mortality did not differ significantly between study groups (P-value >0.05). Our data indicate that in patients undergoing off-pump coronary artery bypass grafting, a single TXA bolus of 1 g generally does not increase the risk of CS. However, the presence and extent of renal insufficiency have a very significant impact on the incidence of CS even after single-dose TXA.© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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