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Associations of preoperative stroke and tranexamic acid administration with convulsive seizures in valvular open-heart surgery
In cardiac surgery, use of the antifibrinolytic agent tranexamic acid (TXA) and acute perioperative stroke are both associated with convulsive seizures. We hypothesized that an older (preoperative) stroke increases the risk of TXA-associated seizures as well. To test this hypothesis, we retrospectiv...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Singapore
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124038/ https://www.ncbi.nlm.nih.gov/pubmed/33822280 http://dx.doi.org/10.1007/s00540-021-02924-w |
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author | Hulde, Nikolai Zittermann, Armin Deutsch, Marcus-André von Dossow, Vera Gummert, Jan F. Koster, Andreas |
author_facet | Hulde, Nikolai Zittermann, Armin Deutsch, Marcus-André von Dossow, Vera Gummert, Jan F. Koster, Andreas |
author_sort | Hulde, Nikolai |
collection | PubMed |
description | In cardiac surgery, use of the antifibrinolytic agent tranexamic acid (TXA) and acute perioperative stroke are both associated with convulsive seizures. We hypothesized that an older (preoperative) stroke increases the risk of TXA-associated seizures as well. To test this hypothesis, we retrospectively analyzed data from 16,110 patients who had undergone open-heart valvular surgery at our institution between 2009 and 2020. The dosing of TXA was moderate. Use of TXA and a history of stroke were both independently associated with convulsive seizure with an adjusted odds ratio (OR) of 2.40 (95%CI: 1.71–3.37) and 1.79 (95%CI: 1.27–2.54), respectively. Compared to patients without TXA administration, the adjusted OR of experiencing a seizure in TXA patients without a history of stroke was 2.44 (95%CI: 1.71–3.46) and in patients receiving TXA with a history of stroke 4.30 (95%CI: 2.65–6.99). However, there was no significant interaction between TXA use and preoperative stroke on convulsive seizures (P = 0.77). Compared to patients without seizure, for patients with seizure, the inverse probability-weighted ORs of in-hospital mortality and 30-day mortality were 3.58 (95%CI: 2.20–5.83) and 4.04 (95%CI: 2.34–6.98), respectively. We conclude that, in patients undergoing open-heart surgery, a history of stroke is independently associated with convulsive seizures but is not a contraindication for TXA use. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00540-021-02924-w. |
format | Online Article Text |
id | pubmed-8124038 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Singapore |
record_format | MEDLINE/PubMed |
spelling | pubmed-81240382021-05-26 Associations of preoperative stroke and tranexamic acid administration with convulsive seizures in valvular open-heart surgery Hulde, Nikolai Zittermann, Armin Deutsch, Marcus-André von Dossow, Vera Gummert, Jan F. Koster, Andreas J Anesth Clinical Report In cardiac surgery, use of the antifibrinolytic agent tranexamic acid (TXA) and acute perioperative stroke are both associated with convulsive seizures. We hypothesized that an older (preoperative) stroke increases the risk of TXA-associated seizures as well. To test this hypothesis, we retrospectively analyzed data from 16,110 patients who had undergone open-heart valvular surgery at our institution between 2009 and 2020. The dosing of TXA was moderate. Use of TXA and a history of stroke were both independently associated with convulsive seizure with an adjusted odds ratio (OR) of 2.40 (95%CI: 1.71–3.37) and 1.79 (95%CI: 1.27–2.54), respectively. Compared to patients without TXA administration, the adjusted OR of experiencing a seizure in TXA patients without a history of stroke was 2.44 (95%CI: 1.71–3.46) and in patients receiving TXA with a history of stroke 4.30 (95%CI: 2.65–6.99). However, there was no significant interaction between TXA use and preoperative stroke on convulsive seizures (P = 0.77). Compared to patients without seizure, for patients with seizure, the inverse probability-weighted ORs of in-hospital mortality and 30-day mortality were 3.58 (95%CI: 2.20–5.83) and 4.04 (95%CI: 2.34–6.98), respectively. We conclude that, in patients undergoing open-heart surgery, a history of stroke is independently associated with convulsive seizures but is not a contraindication for TXA use. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00540-021-02924-w. Springer Singapore 2021-04-06 2021 /pmc/articles/PMC8124038/ /pubmed/33822280 http://dx.doi.org/10.1007/s00540-021-02924-w Text en © The Author(s) 2021, corrected publication 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Clinical Report Hulde, Nikolai Zittermann, Armin Deutsch, Marcus-André von Dossow, Vera Gummert, Jan F. Koster, Andreas Associations of preoperative stroke and tranexamic acid administration with convulsive seizures in valvular open-heart surgery |
title | Associations of preoperative stroke and tranexamic acid administration with convulsive seizures in valvular open-heart surgery |
title_full | Associations of preoperative stroke and tranexamic acid administration with convulsive seizures in valvular open-heart surgery |
title_fullStr | Associations of preoperative stroke and tranexamic acid administration with convulsive seizures in valvular open-heart surgery |
title_full_unstemmed | Associations of preoperative stroke and tranexamic acid administration with convulsive seizures in valvular open-heart surgery |
title_short | Associations of preoperative stroke and tranexamic acid administration with convulsive seizures in valvular open-heart surgery |
title_sort | associations of preoperative stroke and tranexamic acid administration with convulsive seizures in valvular open-heart surgery |
topic | Clinical Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124038/ https://www.ncbi.nlm.nih.gov/pubmed/33822280 http://dx.doi.org/10.1007/s00540-021-02924-w |
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