Tranexamic Acid and the Risk of Delirium after Off-Pump Surgery

Abstract

We investigated whether in patients undergoing off-pump coronary artery bypass grafting surgery a single bolus of 1 g tranexamic acid (TXA) impacts the risk of postoperative delirium using the propensity score matching approach. In 2,757 pairs, the risk of delirium was 4.2% (TXA group) and 5.0% (non-TXA group), with a relative risk in the TXA versus the non-TXA group of 0.83 (95% confidence interval: 0.65–1.07; p = 0.16). There was no significant interaction between TXA administration and renal function on the risk of delirium (p = 0.12). Data indicate that a single bolus of 1 g TXA does not increase the risk of delirium in patients undergoing off-pump surgery.

Keywords

delirium - tranexamic acid - renal impairment

Publication History

Received: 09 December 2021

Accepted: 21 February 2022

Article published online:
06 June 2022

• References

• 1 Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet 2014; 383 (9920): 911-922
• 2 Salluh JI, Wang H, Schneider EB. et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ 2015; 350: h2538
• 3 Lecker I, Wang DS, Romaschin AD, Peterson M, Mazer CD, Orser BA. Tranexamic acid concentrations associated with human seizures inhibit glycine receptors. J Clin Invest 2012; 122 (12) 4654-4666
• 4 Sambin S, Gaspard N, Legros B, Depondt C, De Breucker S, Naeije G. Role of epileptic activity in older adults with delirium, a prospective continuous EEG study. Front Neurol 2019; 10: 263
• 5 Hulde N, Zittermann A, Deutsch MA, von Dossow V, Gummert JF, Koster A. Tranexamic acid and the burden of early neurologic complications in valvular open-heart surgery: a propensity matched analysis in 3227 patients. J Clin Anesth 2021; 73: 110322
• 6 Hulde N, Zittermann A, Gummert JF, von Dossow V, Koster A. Tranexamic acid and the risk of delirium after isolated “on-pump” coronary artery bypass grafting: a propensity score modeled analysis in 3392 patients. J Clin Anesth 2021; 74: 110426
• 7 de Jonge JC, Vinkers CH, Hulshoff Pol HE, Marsman A. GABAergic mechanisms in schizophrenia: linking postmortem and in vivo studies. Front Psychiatry 2017; 8: 118
• 8 Hulde N, Zittermann A, Deutsch MA, von Dossow V, Gummert JF, Koster A. Tranexamic acid and convulsive seizures after off-pump coronary artery bypass surgery: the role of renal insufficiency. Interact Cardiovasc Thorac Surg 2019; 29 (06) 852-854
• 9 Ding L, Chen DX, Li Q. Effects of electroencephalography and regional cerebral oxygen saturation monitoring on perioperative neurocognitive disorders: a systematic review and meta-analysis. BMC Anesthesiol 2020; 20 (01) 254
• 10 Benedetto U, Head SJ, Angelini GD, Blackstone EH. Statistical primer: propensity score matching and its alternatives. Eur J Cardiothorac Surg 2018; 53 (06) 1112-1117