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Critical Care
Published in: Critical Care 5/2010

01-10-2010 | Commentary

Tranexamic acid in cardiac surgery: is there a cause for concern?

Author: David Royston

Published in: Critical Care | Issue 5/2010

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Abstract

The withdrawal of marketing approval for aprotinin resulted in more clinicians administering tranexamic acid to patients at increased risk of bleeding and adverse outcome. The latest in a series of retrospective analyses of observational data is published in Critical Care and suggests an increase in mortality, when compared to data from the aprotinin era, in those patients having surgery when a cardiac chamber is opened. The added observation of an increase in cerebral excitatory phenomena (seizure activity) with tranexamic acid has a known mechanism and questions if such patients should be given this drug.
Literature
1.
Sander M, Spies CD, Martiny V, Rosenthal C, Wernecke KD, von Heymann C: Mortality associated with administration of high-dose tranexamic acid and aprotinin in primary open-heart procedures: a retrospective analysis. Crit Care 2010, 14: R148. 10.1186/cc9216PubMedCentralCrossRefPubMed
2.
3.
Horrow JC, Van Riper DF, Strong MD, Grunewald KE, Parmet JL: The dose-response relationship of tranexamic acid. Anesthesiology 1995, 82: 383-392. 10.1097/00000542-199502000-00009CrossRefPubMed
4.
McIlroy DR, Myles PS, Phillips LE, Smith JA: Antifibrinolytics in cardiac surgical patients receiving aspirin: a systematic review and meta-analysis. Br J Anaesth 2009, 102: 168-178. 10.1093/bja/aen377CrossRefPubMed
5.
Henry D, Carless P, Fergusson D, Laupacis A: The safety of aprotinin and lysine-derived antifibrinolytic drugs in cardiac surgery: a meta-analysis. CMAJ 2009, 180: 183-193.PubMedCentralCrossRefPubMed
6.
Karkouti K, Wijeysundera DN, Yau TM, McCluskey SA, Tait G, Beattie WS: The risk-benefit profile of aprotinin versus tranexamic acid in cardiac surgery. Anesth Analg 2009, 110: 21-29. 10.1213/ANE.0b013e3181c0ea6dCrossRefPubMed
7.
Fodstad H, Forssell A, Liliequist B, Schannong M: Antifibrinolysis with tranexamic acid in aneurysmal subarachnoid hemorrhage: a consecutive controlled clinical trial. Neurosurgery 1981, 8: 158-165. 10.1227/00006123-198102000-00004CrossRefPubMed
8.
Barker JL, Nicoll RA, Padjen A: Studies on convulsants in the isolated frog spinal cord. I. Antagonism of amino acid responses. J Physiol Lond 1975, 245: 521-536.PubMedCentralCrossRefPubMed
9.
Furtmüller R, Schlag MG, Berger M, Hopf R, Huck S, Sieghart W, Redl H: Tranexamic acid, a widely used antifibrinolytic agent, causes convulsions by a gamma-aminobutyric acid(A) receptor antagonistic effect. J Pharmacol Exp Ther 2002, 301: 168-173. 10.1124/jpet.301.1.168CrossRefPubMed
10.
Feffer SE, Parray HR, Westring DW: Seizure after infusion of aminocaproic acid. JAMA 1978, 240: 2468. 10.1001/jama.240.22.2468CrossRefPubMed
11.
Martin K, Wiesner G, Breuer T, Lange R, Tassani P: The risks of aprotinin and tranexamic acid in cardiac surgery: a one-year follow-up of 1188 consecutive patients. Anesth Analg 2008, 107: 1783-1790. 10.1213/ane.0b013e318184bc20CrossRefPubMed
12.
Murkin JM, Falter F, Granton J, Young B, Burt C, Chu M: High-dose tranexamic Acid is associated with nonischemic clinical seizures in cardiac surgical patients. Anesth Analg 2010, 110: 350-353. 10.1213/ANE.0b013e3181c92b23CrossRefPubMed
13.
Royston D, Bidstrup BP, Taylor KM, Sapsford RN: Effect of aprotinin on need for blood transfusion after repeat open-heart surgery. Lancet 1987, 2: 1289-1291. 10.1016/S0140-6736(87)91190-1CrossRefPubMed
Metadata
Title
Tranexamic acid in cardiac surgery: is there a cause for concern?
Author
David Royston
Publication date
01-10-2010
Publisher
BioMed Central
Published in
Critical Care / Issue 5/2010
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc9227

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