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SOURCE: Lecker I, et al. Tranexamic acid-associated seizures: Causes and treatment. Ann Neurol 2016;79:18-26.
Tranexamic acid (TXA) is one of the most commonly used antifibrinolytic drugs, often utilized in the perioperative setting to reduce the risk of blood loss and to decrease the need for blood transfusions. TXA is a synthetic lysine-analogue that competitively inhibits the conversion of plasminogen to plasmin, thus reducing fibrin-containing clots.1 In general, antifibrinolytic agents are safe with few serious side effects, but recent observational studies and case reports have shown an increased incidence of associated seizures, mostly with TXA, and often are associated with cardiac procedures, which can lead to increased length of stay and higher mortality rates.2
Per the authors, “off-label” indications and usages for TXA have greatly expanded; thus, retrospective analyses have shown an increased incidence of TXA-associated seizures from 0.5-1.0% to 6.4-7.3% as higher dosages of TXA are used.2 Several other risk factors have also been identified, including female gender, > 70 years of age, poor overall health status, and certain health conditions, including renal dysfunction and previous neurological or cardiovascular disorders. Seizures also more commonly are associated with cardiac surgeries, particularly those with prolonged cardiopulmonary bypass time or prolonged aortic cross-clamp time, although seizures have been reported with...