Tranexamic acid-induced involuntary movements and convulsions in patients undergoing cardiac and thoracic aortic surgery using cardiopulmonary bypass

Abstract

Purpose: To describe the clinical features of postoperative involuntary movements including convulsions resulting from use of intravenous high-dose tranexamic acid (TXA) in patients undergoing cardiac and thoracic aortic surgery. We also aimed to identify associated risk factors.

Methods: This retrospective single-center study examined 191 patients who received intravenous TXA during cardiac and/or thoracic aortic surgery with cardiopulmonary bypass in our institution. Multivariable logistic regression was performed to identify independent predictors of postoperative involuntary movements/convulsions.

Results: TXA-associated involuntary movements/convulsions were observed in 25 patients (13.1%). Involuntary movements included convulsions, myoclonic jerks of limbs and/or facial muscles, and action tremors of the body, especially the head and hands. The median time from the last dose of TXA to the first involuntary movement/convulsion was 7.3 hours. The median duration of involuntary movements/convulsions was 1 day. Convulsions did not progress to status epilepticus. Intensive care unit (ICU) stay was significantly longer in patients with involuntary movements/convulsions than in those without (p < 0.001). In multivariate analysis, the following variables were independent predictors of involuntary movements/convulsions: total TXA dose (odds ratio [OR], 1.10; p = 0.047), dialysis treatment (OR, 5.32; p = 0.016), and a history of stroke (OR, 3.30; p = 0.021).

Conclusions: In addition to convulsions, myoclonus and tremors were also observed as TXA-associated involuntary movements. Although these abnormal movements generally disappeared within a short period of time, they were associated with longer ICU stay. Caution should be exercised when administering high doses of TXA to dialysis patients and patients with a history of stroke.