Intraoperative tranexamic acid is associated with postoperative stroke in patients undergoing cardiac surgeryReportar como inadecuado




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Background

Stroke is a devastating and potentially preventable complication of cardiac surgery. Tranexamic acid TXA is a commonly antifibrinolytic agent in cardiac surgeries with cardiopulmonary bypass CPB, however, there is concern that it might increase incidence of stroke after cardiac surgery. In this retrospective study, we investigated whether TXA usage could increase postoperative stroke in cardiac surgery.

Methods

A retrospective study was conducted from January 1, 2010, to December 31, 2015, in 2,016 patients undergoing cardiac surgery, 664 patients received intravenous TXA infusion and 1,352 patients did not receive any antifibrinolytic agent. Univariate and propensity-weighted multivariate regression analysis were applied for data analysis.

Results

Intraoperative TXA administration was associated with postoperative stroke 1.7% vs. 0.5%; adjusted OR, 4.11; 95% CI, 1.33 to 12.71; p = 0.014 and coma adjusted OR, 2.77; 95% CI, 1.06 to 7.26; p = 0.038 in cardiac surgery. As subtype analysis was performed, TXA administration was still associated with postoperative stroke 1.7% vs. 0.3%; adjusted OR, 5.78; 95% CI, 1.34 to 27.89; p = 0.018 in patients undergoing valve surgery or multi-valve surgery only, but was not associated with postoperative stroke 1.7% vs. 1.3%; adjusted OR, 5.21; 95% CI, 0.27 to 101.17; p = 0.276 in patients undergoing CABG surgery only. However, TXA administration was not associated with postoperative mortality adjusted OR, 1.31; 95% CI, 0.56 to 3.71; p = 0.451, seizure adjusted OR, 1.13; 95% CI, 0.42 to 3.04; p = 0.816, continuous renal replacement therapy adjusted OR, 1.36; 95% CI, 0.56 to 3.28; p = 0.495 and resternotomy for postoperative bleeding adjusted OR, 1.55; 95% CI, 0.55 to 4.30; p = 0.405. No difference was found in postoperative ventilation time adjusted B -1.45; SE, 2.33; p = 0.535, length of intensive care unit stay adjusted B -0.12; SE, 0.25; p = 0.633 and length of hospital stay adjusted B, 0.48; SE, 0.58; p = 0.408.

Conclusions

Based on the 5-year experience of TXA administration in cardiac surgery with CPB, we found that postoperative stroke was associated with intraoperative TXA administration in patients undergoing cardiac surgery, especially in those undergoing valve surgeries only. This study may suggest that TXA should be administrated according to clear indications after evaluating the bleeding risk in patients undergoing cardiac surgery, especially in those with high stroke risk.



Autor: Zhen-feng Zhou, Feng-jiang Zhang, Yang- fan Huo, Yun-xian Yu, Li-na Yu, Kai Sun, Li-hong Sun, Xiu-fang Xing, Min Yan

Fuente: http://plos.srce.hr/



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