Tranexamic acid and the risk of delirium after isolated “on-pump” coronary artery bypass grafting: A propensity score modeled analysis in 3392 patients
[...]the neurotoxic effect of TXA is not only limited to CS [3,4], but also leads to delirium [8]. Based on these results, we conclude that in patients undergoing isolated on-pump CABG, even a moderate dose of TXA is associated with a significantly increased risk of delirium. [...]even a moderate do...
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| Veröffentlicht in: | Journal of clinical anesthesia 2021-11, Vol.74, p.110426-110426, Article 110426 |
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| creator | Hulde, Nikolai Zittermann, Armin Gummert, Jan F. von Dossow, Vera Koster, Andreas |
| description | [...]the neurotoxic effect of TXA is not only limited to CS [3,4], but also leads to delirium [8]. Based on these results, we conclude that in patients undergoing isolated on-pump CABG, even a moderate dose of TXA is associated with a significantly increased risk of delirium. [...]even a moderate dose of TXA should be given with caution.Funding This study was partly financed by the research fund of the Institute of Anesthesiology and Pain Therapy, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Germany.Author contribution NH and AK designed the study. Parameter With TXA treatment Without TXA treatment P-value (n = 2546) (n = 846) Age (years)a 69 (61;75) 69 (61;74) 0.09 Sex, Malesb 210 (79.1) 650 (76.8) 0.18 Body Mass Index (kg/m2)a 27.8 (25.2;31.0) 27.8 (25.0;30.8) 0.98 Diabetes Mellitusb 940 (37.0) 320 (37.8) 0.68 Hypertensionb 2171 (85.4) 733 (86.6) 0.4 Strokeb 118 (4.6) 27 (3.2) 0.08 Myocardial Infarctionb 1109 (43.6) 315 (37.2) 0.001 Chronic Obstructive Pulmonary Diseaseb 246 (9.7) 78 (9.2) 0.74 Left Ventricular Ejection Fraction (%)a 55 (40;60) 56 (45;60) 50%b 253 (10.0) 70 (8.3) 0.16 Euroscore II (%)a 2.3 (1.2;5.5) 1.8 (1.1;4.1) |
| doi_str_mv | 10.1016/j.jclinane.2021.110426 |
| format | Article |
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Based on these results, we conclude that in patients undergoing isolated on-pump CABG, even a moderate dose of TXA is associated with a significantly increased risk of delirium. [...]even a moderate dose of TXA should be given with caution.Funding This study was partly financed by the research fund of the Institute of Anesthesiology and Pain Therapy, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Germany.Author contribution NH and AK designed the study. Parameter With TXA treatment Without TXA treatment P-value (n = 2546) (n = 846) Age (years)a 69 (61;75) 69 (61;74) 0.09 Sex, Malesb 210 (79.1) 650 (76.8) 0.18 Body Mass Index (kg/m2)a 27.8 (25.2;31.0) 27.8 (25.0;30.8) 0.98 Diabetes Mellitusb 940 (37.0) 320 (37.8) 0.68 Hypertensionb 2171 (85.4) 733 (86.6) 0.4 Strokeb 118 (4.6) 27 (3.2) 0.08 Myocardial Infarctionb 1109 (43.6) 315 (37.2) 0.001 Chronic Obstructive Pulmonary Diseaseb 246 (9.7) 78 (9.2) 0.74 Left Ventricular Ejection Fraction (%)a 55 (40;60) 56 (45;60) <0.001 Estimated Glomerular Filtration Rate (ml/min/1.73m2)a 71.8 (55.2;85.0) 72.5 (55.1;84.1) 0.88 Three Vessel Diseaseb 2176 (85.6) 722 (85.3) 0.8 Peripheral Artery Diseaseb 373 (14.7) 135 (16.0) 0.37 Carotid Stenosis >50%b 253 (10.0) 70 (8.3) 0.16 Euroscore II (%)a 2.3 (1.2;5.5) 1.8 (1.1;4.1) <0.001 Current/Previous Smokersb 1111 (43.7) 375 (44.3) 0.78 Hemoglobin (mg/dl)a 13.9 (12.7;14.9) 13.8 (12.6;14.9) 0.64 Previous Cardiac Surgeryb 233 (9.2) 35 (4.1) <0.001 Aspirin Useb 1892 (74.4) 574 (67.8) <0.001 Urgent/Emergent Operationb 758 (29.8) 228 (27.0) 0.12 Surgical Periodb 2009–2012 1294 (50.9) 639 (75.5) <0.001 2013–2016 663 (26.1) 101 (11.9) <0.001 2017–2020 585 (23.0) 106 (12.5) <0.001 Table 1 Baseline characteristics of patients undergoing isolated coronary artery bypass grafting with cardiopulmonary bypass.]]></description><identifier>ISSN: 0952-8180</identifier><identifier>EISSN: 1873-4529</identifier><identifier>DOI: 10.1016/j.jclinane.2021.110426</identifier><identifier>PMID: 34182263</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Antifibrinolytic agents ; Convulsions & seizures ; Coronary Artery Bypass - adverse effects ; Coronary vessels ; Delirium ; Delirium - epidemiology ; Delirium - etiology ; Editing ; Heart surgery ; Humans ; Mental disorders ; Neurotoxicity ; Patients ; Propensity Score ; Software ; Stroke ; Tranexamic Acid - adverse effects ; Veins & arteries ; Writing</subject><ispartof>Journal of clinical anesthesia, 2021-11, Vol.74, p.110426-110426, Article 110426</ispartof><rights>2021</rights><rights>Copyright Elsevier Limited Nov 2021</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-b41964a35fc80714534614b42cd4758a65f5dee03d186671c1424fdcc3f73fb43</citedby><cites>FETCH-LOGICAL-c396t-b41964a35fc80714534614b42cd4758a65f5dee03d186671c1424fdcc3f73fb43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2580912736?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974,64362,64364,64366,72216</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34182263$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hulde, Nikolai</creatorcontrib><creatorcontrib>Zittermann, Armin</creatorcontrib><creatorcontrib>Gummert, Jan F.</creatorcontrib><creatorcontrib>von Dossow, Vera</creatorcontrib><creatorcontrib>Koster, Andreas</creatorcontrib><title>Tranexamic acid and the risk of delirium after isolated “on-pump” coronary artery bypass grafting: A propensity score modeled analysis in 3392 patients</title><title>Journal of clinical anesthesia</title><addtitle>J Clin Anesth</addtitle><description><![CDATA[[...]the neurotoxic effect of TXA is not only limited to CS [3,4], but also leads to delirium [8]. Based on these results, we conclude that in patients undergoing isolated on-pump CABG, even a moderate dose of TXA is associated with a significantly increased risk of delirium. [...]even a moderate dose of TXA should be given with caution.Funding This study was partly financed by the research fund of the Institute of Anesthesiology and Pain Therapy, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Germany.Author contribution NH and AK designed the study. Parameter With TXA treatment Without TXA treatment P-value (n = 2546) (n = 846) Age (years)a 69 (61;75) 69 (61;74) 0.09 Sex, Malesb 210 (79.1) 650 (76.8) 0.18 Body Mass Index (kg/m2)a 27.8 (25.2;31.0) 27.8 (25.0;30.8) 0.98 Diabetes Mellitusb 940 (37.0) 320 (37.8) 0.68 Hypertensionb 2171 (85.4) 733 (86.6) 0.4 Strokeb 118 (4.6) 27 (3.2) 0.08 Myocardial Infarctionb 1109 (43.6) 315 (37.2) 0.001 Chronic Obstructive Pulmonary Diseaseb 246 (9.7) 78 (9.2) 0.74 Left Ventricular Ejection Fraction (%)a 55 (40;60) 56 (45;60) <0.001 Estimated Glomerular Filtration Rate (ml/min/1.73m2)a 71.8 (55.2;85.0) 72.5 (55.1;84.1) 0.88 Three Vessel Diseaseb 2176 (85.6) 722 (85.3) 0.8 Peripheral Artery Diseaseb 373 (14.7) 135 (16.0) 0.37 Carotid Stenosis >50%b 253 (10.0) 70 (8.3) 0.16 Euroscore II (%)a 2.3 (1.2;5.5) 1.8 (1.1;4.1) <0.001 Current/Previous Smokersb 1111 (43.7) 375 (44.3) 0.78 Hemoglobin (mg/dl)a 13.9 (12.7;14.9) 13.8 (12.6;14.9) 0.64 Previous Cardiac Surgeryb 233 (9.2) 35 (4.1) <0.001 Aspirin Useb 1892 (74.4) 574 (67.8) <0.001 Urgent/Emergent Operationb 758 (29.8) 228 (27.0) 0.12 Surgical Periodb 2009–2012 1294 (50.9) 639 (75.5) <0.001 2013–2016 663 (26.1) 101 (11.9) <0.001 2017–2020 585 (23.0) 106 (12.5) <0.001 Table 1 Baseline characteristics of patients undergoing isolated coronary artery bypass grafting with cardiopulmonary bypass.]]></description><subject>Antifibrinolytic agents</subject><subject>Convulsions & seizures</subject><subject>Coronary Artery Bypass - adverse effects</subject><subject>Coronary vessels</subject><subject>Delirium</subject><subject>Delirium - epidemiology</subject><subject>Delirium - etiology</subject><subject>Editing</subject><subject>Heart surgery</subject><subject>Humans</subject><subject>Mental disorders</subject><subject>Neurotoxicity</subject><subject>Patients</subject><subject>Propensity Score</subject><subject>Software</subject><subject>Stroke</subject><subject>Tranexamic Acid - adverse effects</subject><subject>Veins & arteries</subject><subject>Writing</subject><issn>0952-8180</issn><issn>1873-4529</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkc1u1TAQhS0EopfCK1QjsWGTi__iJKyoKv6kSmzK2nLsSfEliYOdVGTX9wBerk-Co9uyYMNqFv7OmfE5hJwxumeUqdeH_cH2fjQj7jnlbM8YlVw9IjtWV6KQJW8ekx1tSl7UrKYn5FlKB0ppfmBPyYmQrOZciR35eRWzxw8zeAvGegdmdDB_RYg-fYPQgcPeR78MYLoZI_gUejOjg7vbX2EspmWY7m5_gw0xjCauYGKmVmjXyaQE1zGr_Hj9Bs5himHCMfl5hZRxhCFkb9w2mn5NPoEfQYiGw2Rmj-OcnpMnnekTvrifp-TL-3dXFx-Ly88fPl2cXxZWNGouWskaJY0oO1vTislSSMVkK7l1sipro8qudIhUOFYrVTHLJJeds1Z0lehaKU7Jq6NvPvH7gmnWg08W-z4nE5akeSmVoqwRG_ryH_QQlpg_sFE1bRivhMqUOlI2hpQidnqKfsjxaEb1Vp8-6If69FafPtaXhWf39ks7oPsre-grA2-PAOY8bjxGnWzOyqLzEe2sXfD_2_EHq-KxjA</recordid><startdate>202111</startdate><enddate>202111</enddate><creator>Hulde, Nikolai</creator><creator>Zittermann, Armin</creator><creator>Gummert, Jan F.</creator><creator>von Dossow, Vera</creator><creator>Koster, Andreas</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202111</creationdate><title>Tranexamic acid and the risk of delirium after isolated “on-pump” coronary artery bypass grafting: A propensity score modeled analysis in 3392 patients</title><author>Hulde, Nikolai ; Zittermann, Armin ; Gummert, Jan F. ; von Dossow, Vera ; Koster, Andreas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-b41964a35fc80714534614b42cd4758a65f5dee03d186671c1424fdcc3f73fb43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Antifibrinolytic agents</topic><topic>Convulsions & seizures</topic><topic>Coronary Artery Bypass - adverse effects</topic><topic>Coronary vessels</topic><topic>Delirium</topic><topic>Delirium - epidemiology</topic><topic>Delirium - etiology</topic><topic>Editing</topic><topic>Heart surgery</topic><topic>Humans</topic><topic>Mental disorders</topic><topic>Neurotoxicity</topic><topic>Patients</topic><topic>Propensity Score</topic><topic>Software</topic><topic>Stroke</topic><topic>Tranexamic Acid - adverse effects</topic><topic>Veins & arteries</topic><topic>Writing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hulde, Nikolai</creatorcontrib><creatorcontrib>Zittermann, Armin</creatorcontrib><creatorcontrib>Gummert, Jan F.</creatorcontrib><creatorcontrib>von Dossow, Vera</creatorcontrib><creatorcontrib>Koster, Andreas</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hulde, Nikolai</au><au>Zittermann, Armin</au><au>Gummert, Jan F.</au><au>von Dossow, Vera</au><au>Koster, Andreas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Tranexamic acid and the risk of delirium after isolated “on-pump” coronary artery bypass grafting: A propensity score modeled analysis in 3392 patients</atitle><jtitle>Journal of clinical anesthesia</jtitle><addtitle>J Clin Anesth</addtitle><date>2021-11</date><risdate>2021</risdate><volume>74</volume><spage>110426</spage><epage>110426</epage><pages>110426-110426</pages><artnum>110426</artnum><issn>0952-8180</issn><eissn>1873-4529</eissn><abstract><![CDATA[[...]the neurotoxic effect of TXA is not only limited to CS [3,4], but also leads to delirium [8]. Based on these results, we conclude that in patients undergoing isolated on-pump CABG, even a moderate dose of TXA is associated with a significantly increased risk of delirium. [...]even a moderate dose of TXA should be given with caution.Funding This study was partly financed by the research fund of the Institute of Anesthesiology and Pain Therapy, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Germany.Author contribution NH and AK designed the study. Parameter With TXA treatment Without TXA treatment P-value (n = 2546) (n = 846) Age (years)a 69 (61;75) 69 (61;74) 0.09 Sex, Malesb 210 (79.1) 650 (76.8) 0.18 Body Mass Index (kg/m2)a 27.8 (25.2;31.0) 27.8 (25.0;30.8) 0.98 Diabetes Mellitusb 940 (37.0) 320 (37.8) 0.68 Hypertensionb 2171 (85.4) 733 (86.6) 0.4 Strokeb 118 (4.6) 27 (3.2) 0.08 Myocardial Infarctionb 1109 (43.6) 315 (37.2) 0.001 Chronic Obstructive Pulmonary Diseaseb 246 (9.7) 78 (9.2) 0.74 Left Ventricular Ejection Fraction (%)a 55 (40;60) 56 (45;60) <0.001 Estimated Glomerular Filtration Rate (ml/min/1.73m2)a 71.8 (55.2;85.0) 72.5 (55.1;84.1) 0.88 Three Vessel Diseaseb 2176 (85.6) 722 (85.3) 0.8 Peripheral Artery Diseaseb 373 (14.7) 135 (16.0) 0.37 Carotid Stenosis >50%b 253 (10.0) 70 (8.3) 0.16 Euroscore II (%)a 2.3 (1.2;5.5) 1.8 (1.1;4.1) <0.001 Current/Previous Smokersb 1111 (43.7) 375 (44.3) 0.78 Hemoglobin (mg/dl)a 13.9 (12.7;14.9) 13.8 (12.6;14.9) 0.64 Previous Cardiac Surgeryb 233 (9.2) 35 (4.1) <0.001 Aspirin Useb 1892 (74.4) 574 (67.8) <0.001 Urgent/Emergent Operationb 758 (29.8) 228 (27.0) 0.12 Surgical Periodb 2009–2012 1294 (50.9) 639 (75.5) <0.001 2013–2016 663 (26.1) 101 (11.9) <0.001 2017–2020 585 (23.0) 106 (12.5) <0.001 Table 1 Baseline characteristics of patients undergoing isolated coronary artery bypass grafting with cardiopulmonary bypass.]]></abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34182263</pmid><doi>10.1016/j.jclinane.2021.110426</doi><tpages>1</tpages></addata></record> |
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| subjects | Antifibrinolytic agents Convulsions & seizures Coronary Artery Bypass - adverse effects Coronary vessels Delirium Delirium - epidemiology Delirium - etiology Editing Heart surgery Humans Mental disorders Neurotoxicity Patients Propensity Score Software Stroke Tranexamic Acid - adverse effects Veins & arteries Writing |
| title | Tranexamic acid and the risk of delirium after isolated “on-pump” coronary artery bypass grafting: A propensity score modeled analysis in 3392 patients |
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