Antifibrinolytic therapy in cardiac surgery.
Bleeding remains an important complication after repeat and complicated cardiac surgery. Although aprotinin has recently been approved by the Food and Drug Administration for use as an antifibrinolytic agent, many surgeons continue to have concerns about its added cost and potential side effects. We review here the current state of antifibrinolytic therapy for excessive bleeding in cardiothoracic surgery and suggest the use of a single intravenous dose of 10 g of epsilon-aminocaproic acid immediately before cardiopulmonary bypass as a safe, inexpensive, and effective alternative to aprotinin. Further clinical and laboratory studies are needed to confirm or modify this protocol.
Chen
R H
RH
Department of Cardiovascular Surgery, Texas Heart Institute, Houston 77030, USA.
Frazier
O H
OH
Cooley
D A
DA
D015119:Aminocaproic Acid / Q000008:administration & dosage / Q000009:adverse effects; D000933:Antifibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007611:Aprotinin / Q000008:administration & dosage / Q000009:adverse effects; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000503:physiopathology / Q000517:prevention & control; D002315:Cardiopulmonary Bypass; D004305:Dose-Response Relationship, Drug; D006331:Heart Diseases / Q000097:blood / Q000601:surgery*; D006801:Humans; D019106:Postoperative Hemorrhage / Q000097:blood / Q000517:prevention & control*; D011292:Premedication
D000933:Antifibrinolytic Agents; D007611:Aprotinin; D015119:Aminocaproic Acid