Epsilon-aminocaproic acid in the treatment of patients with acute promyelocytic leukemia and acquired alpha-2-plasmin inhibitor deficiency.
Patients with acute promyelocytic leukemia often develop bleeding diatheses during treatment. In seven patients who had this disease, the plasma level of alpha-2-plasmin inhibitor was the best predictor of severity of coagulopathy and bleeding. Clinical bleeding occurred when alpha-2-plasmin inhibitor levels measured less than 30% of normal levels. Patients with acute promyelocytic leukemia who had acquired deficiencies of alpha-2-plasmin inhibitor were considered to have deficits similar to those in persons congenitally deficient in alpha-2-plasmin inhibitor, and were assumed to be at increased risk for bleeding. Treatment with the fibrinolytic inhibitor, epsilon-aminocaproic acid, along with heparin resulted in prompt cessation of bleeding, reversal of laboratory evidence of fibrinolysis, and a decreased need for blood product support. The only thrombotic complication--thrombosis around a central venous catheter--resolved when treatment with epsilon-aminocaproic acid was discontinued. Epsilon-aminocaproic acid is a safe and effective therapy for those patients with acute promyelocytic leukemia who develop coagulopathy associated with low levels of alpha-2-plasmin inhibitor.
Schwartz
B S
BS
Williams
E C
EC
Conlan
M G
MG
Mosher
D F
DF
D000614:Aminocaproates / Q000627:therapeutic use*; D015119:Aminocaproic Acid / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000188:drug therapy* / Q000209:etiology; D004359:Drug Therapy, Combination; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000188:drug therapy*; D000979:alpha-2-Antiplasmin / Q000172:deficiency*
D000614:Aminocaproates; D000979:alpha-2-Antiplasmin; D006493:Heparin; D015119:Aminocaproic Acid