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Seizures Associated With Tranexamic Acid for Cardiac Surgery: A Meta-Analysis of Randomized and Non-Randomized Studies

Tuesday, September 12, 2017

Submitted by


Source Name: The Journal of Cardiovascular Surgery


Hisato Takagi, Tomo Ando, Takuya Umemoto, on behalf of All-Literature Investigation of Cardiovascular Evidence (ALICE) group

This is a summary of the literature as to the prevalence of seizures in patients who have had tranexamic acid during their cardiac surgery. 


Well, there you have it. Medicine at its worst yet again. In the mid 1990s we were told albumin was bad for patients on ITU, because as it was given to all patients during their terminal phases, it was the cause! 15 years later "sorry, that was wrong". Trasylol was withdrawn as it "caused more strokes" , used in full dose in the very elderly - so not available for eg Jahovas witnesses , etc etc. That was reversed. Now it is tranexamic acid the culprit. In a study of studies etc with a large proportion finding no difference, yet the authors choose in their conclusion the +ve findings. I criticise the journal for not screening the paper better. Have you seen any seizures in your patients?? I use it in every case last 20 years. 1 gm on induction 1g/hr, total 4-5 gm. In the USA they use 10-15 gm! Never had a seizure. As part of our efforts to avoid blood or blood products it is a useful agent.
Good timing of publication when we are experiencing shortage of aminocaproic acid (Amicar). If switch over from Amicar to TXA, seizure is major concern.
a little perspective. meta-analysis w/ glaring analytical issues in JCVS (IF = 2.1) - less than helpful. 4 fold increase in seizure rate of 0.1% (NEJM - 2017)? Lies, DAMN LIES and then there are the stories statisticians tell ex post facto (meta-analysis). Then again, the data to support TXA reduction in bleeding is very strong across many surgical specialties. The baby with the bath water comes to mind.
Having asked colleagues, one unit in the North has had incidents of seizures and they blame TXA, because they read it somewhere. This was in high risk cases with a lot of other things going on. In the absence of properly designed controlled prospective studies, I should not like to stop using a very useful drug.

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