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Among patients having cardiac surgery, topical administration of tranexamic acid does not reduce the incidence of seizure when compared with intravenous tranexamic acid, according to a study published online April 8 in Circulation to coincide with the annual meeting of the American College of Cardiology, held from April 6 to 8 in Atlanta.
Andre Lamy, M.D., from the Population Health Research Institute in Hamilton, Ontario, Canada, and colleagues assessed whether topical tranexamic acid reduces the risk for in-hospital seizure without increasing the risk for transfusion among patients undergoing cardiac surgery with cardiopulmonary bypass. The analysis included 3,242 patients (treated at 16 hospitals in six countries) who were randomly assigned (1:1) to either intravenous tranexamic acid (control) through surgery or topical tranexamic acid (treatment) at the end of surgery.
The researchers found that in-hospital seizure occurred in 0.2 percent in the topical group and in 0.7 percent in the intravenous group (absolute risk difference, −0.5 percent; 95 percent confidence interval, −0.9 to 0.03; P = 0.07). In the topical group, red blood cell transfusion occurred in 35.1 percent of patients compared with 26.8 percent of patients in the intravenous group (absolute risk difference, 8.3 percent; 95 percent confidence interval, 5.2 to 11.5; P = 0.007). Compared with the intravenous group, the absolute risk difference in transfusion of four or more units of red blood cells in the topical group was 8.2 percent (95 percent confidence interval, 3.4 to 12.9).
“Among patients having cardiac surgery, topical administration of tranexamic acid resulted in an 8.3 percent absolute increase in transfusion without reducing the incidence of seizure, compared to intravenous tranexamic acid,” the authors write.
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