Institute of Anesthesiology and Pain Therapy, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany.
Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany.
Thorac Cardiovasc Surg. 2023 Apr;71(3):181-188. doi: 10.1055/s-0041-1724035. Epub 2021 Mar 4.
In valvular open-heart surgery, data regarding the effect of a moderate dose of tranexamic acid (TXA) on clinical outcomes are limited.
Out of a cohort of 13,293 patients, we performed a propensity-score-matched analysis in 6,106 patients and assessed the risk of convulsive seizures (CS, primary endpoint), stroke, renal replacement therapy, and mortality (secondary endpoints). In the entire study cohort of 13,293 patients, we also assessed the multivariable-adjusted association of CS with postoperative outcomes.
The risk of CS was significantly higher in the TXA group (2.4%; = 72) than in the non-TXA group (1.0%; = 32), with a relative risk ratio (RR) of 2.28 (95% confidence interval [CI]: 1.50-3.47; < 0.001). The risk of CS was also higher in patients receiving TXA doses ≥25 mg/kg body weight (3.7%; = 40) than in patients receiving <25 mg/kg body weight (1.6%; = 32; < 0.001). Perioperative secondary clinical endpoints and 1-year mortality did not differ significantly between study groups (-value > 0.05). Compared with non-CS patients ( = 13,000), patients with nonhemorrhagic, nonembolic CS ( = 253) revealed higher multivariable-adjusted in-hospital risks of stroke (RR: 3.82 [95% CI: 2.44-5.60; < 0.001]) and mortality (RR: 2.07 [95% CI: 1.23-3.48; = 0.006]), and a higher 1-year mortality risk (RR: 1.85 [95% CI: 1.42-2.41; < 0.001]).
A moderate TXA dose was associated with a significantly higher risk of seizure, but not with other clinical complications such as stroke, renal replacement therapy, and mortality. However, in the small group of patients experiencing a seizure, the risks of stroke and short- and mid-term mortality were substantially higher than in patients not experiencing a seizure, indicating that the use of a low-dose TXA protocol (<25 mg/kg body weight) should be considered.
在心脏直视手术中，关于中等剂量氨甲环酸（TXA）对临床结局影响的数据有限。
在 13293 例患者队列中，我们对 6106 例患者进行了倾向评分匹配分析，并评估了癫痫发作（CS，主要终点）、中风、肾脏替代治疗和死亡率（次要终点）的风险。在整个 13293 例患者队列中，我们还评估了 CS 与术后结局的多变量调整关联。
TXA 组 CS 的风险明显高于非 TXA 组（2.4%， = 72），相对风险比（RR）为 2.28（95%置信区间[CI]：1.50-3.47； < 0.001）。接受 TXA 剂量≥25 mg/kg 体重的患者（3.7%， = 40）的 CS 风险也高于接受 <25 mg/kg 体重的患者（1.6%， = 32； < 0.001）。研究组之间围手术期次要临床终点和 1 年死亡率无显著差异（-值> 0.05）。与非 CS 患者（ = 13000）相比，非出血性、非栓塞性 CS 患者（ = 253）的多变量调整住院风险更高，包括中风（RR：3.82[95%CI：2.44-5.60； < 0.001]）和死亡率（RR：2.07[95%CI：1.23-3.48； = 0.006]），以及更高的 1 年死亡率风险（RR：1.85[95%CI：1.42-2.41； < 0.001]）。
中等剂量 TXA 与癫痫发作风险显著增加相关，但与中风、肾脏替代治疗和死亡率等其他临床并发症无关。然而，在经历癫痫发作的小患者组中，中风和短期至中期死亡率的风险明显高于未经历癫痫发作的患者，这表明应考虑使用低剂量 TXA 方案（<25 mg/kg 体重）。
