• J Fan, A Jerath, K S Pang, B Bojko, J Pawliszyn, J M Karski, T Yau, S McCluskey, and M Wąsowicz.
• Department of Surgery, University of Toronto and Division of Cardiac Surgery, Toronto General Hospital, Toronto, Canada. drvvs@rediffmail.com
• Anaesthesia. 2012 Nov 1;67(11):1242-50.

AbstractWe conducted a study to assess pharmacokinetics of high-dose tranexamic acid for 24 h after administration of the drug in patients undergoing cardiac surgery with cardiopulmonary bypass. High-dose tranexamic acid involved a bolus of 30 mg.kg(-1) infused over 15 min followed by a 16 mg.kg(-1) .h(-1) infusion until chest closure with a 2 mg.kg(-1) load within the pump prime. Tranexamic acid followed first-order kinetics best described using a two-compartment model, with a total body clearance that approximated the glomerular filtration rate. Mean plasma tranexamic acid concentrations during the intra-operative period and in the first 6 postoperative hours were consistently higher than the suggested threshold to achieve 100% inhibition and 80% inhibition of tissue plasminogen activator. With recent studies implicating high-dose tranexamic acid as a possible aetiology of postoperative seizures following cardiac surgery, the minimum effective yet safe dose of tranexamic acid in high-risk cardiac surgery needs to be refined.Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

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