Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
J Cardiothorac Vasc Anesth. 2020 Mar;34(3):782-790. doi: 10.1053/j.jvca.2019.06.042. Epub 2019 Jul 4.
Tranexamic acid reduces blood loss and transfusion requirements with no significant thrombotic adverse effects. Postoperative seizures have been seen in cardiac surgical patients in association with patient (advanced age, underlying neurologic disease, chronic kidney disease); surgical (open cardiac procedures, long bypass times); and drug (high tranexamic acid dose) risk factors. Tranexamic acid dosing regimens should be decreased in patients with chronic kidney dysfunction secondary to reduced clearance and drug accumulation. Optimal dosing for cardiac surgical patients has been recommended. Additional research is required to determine dosing regimens in major noncardiac surgery and plasma concentration levels associated with inducing seizures.
氨甲环酸可减少失血和输血需求，且无明显血栓不良事件。心脏外科手术患者术后癫痫发作与患者（高龄、基础神经疾病、慢性肾病）、手术（开胸心脏手术、长体外循环时间）和药物（高氨甲环酸剂量）相关危险因素相关。由于清除率降低和药物蓄积，慢性肾功能障碍患者应减少氨甲环酸剂量。建议对心脏外科手术患者进行最佳剂量。还需要进一步研究来确定主要非心脏手术中的剂量方案和与诱发癫痫相关的血浆浓度水平。
