13:10 PM

Tranexamic Acid in Arthroplasty Does Not Increase Seizures

Anesthesiology News reports on the findings of an HSS study showing the use of tranexamic acid during orthopedic surgery was not associated with increased odds of perioperative seizure, even in patients with a history of seizure.

HSS anesthesiologist and senior study author Stavros G. Memtsoudis, MD, PhD, MBA and colleagues queried the Premier Healthcare national database for data on patients who had undergone total hip and knee arthroplasty between 2012 and 2016 (N=918,918). As part of that query, the primary exposure of interest was tranexamic acid administration on the day of surgery. Patients were then stratified according to a preoperative history of seizures or seizure disorders.

The researchers reported in an abstract that tranexamic acid was used in 45.9% of joint arthroplasty recipients during the period under study (n=421,890). The study found no significant differences in the incidence of perioperative seizure between patients who received tranexamic acid (n=51; 0.01%) and their counterparts who did not (n=80; 0.02%) (P=0.11). Among the patients who experienced a perioperative seizure, only one of the 51 who received tranexamic acid later died (2.0%), compared with three of the 80 patients who did not receive tranexamic acid (3.8%) (P=0.56). The investigators then restricted the analysis to 8,252 patients with a preoperative history of seizures and/or epilepsy. Of these, two patients who received tranexamic acid had a seizure (0.06%), compared with one who did not (0.02%) (P=0.392). None of these three patients died.

A multivariable logistic regression model also was run, adjusting for covariates such as patient age, sex, comorbidities, obesity, sleep apnea, procedure group, anesthesia type and procedure year. This analysis found that tranexamic acid was not a significant predictor of perioperative seizure, regardless of preoperative history of seizures (odds ratio, 3.11; 95% CI, 0.28-34.53).

“So, we conclude that people who received tranexamic acid were not at increased risk for the development of perioperative seizures,” said Dr. Memtsoudis. “Given that we know that tranexamic acid decreases rates of blood transfusions, then the theoretical risk of seizures does not justify withholding it.”

Read the full article at Anesthesiologynews.com.