Reduction of bleeding after heart operations through the prophylactic use of epsilon-aminocaproic acid.
Excessive postoperative bleeding after heart operations continues to be a source of morbidity. This prospective double-blind study evaluated epsilon-aminocaproic acid as an agent to reduce postoperative bleeding and investigated its mode of action. One hundred three patients were randomly assigned to receive either 30 gm epsilon-aminocaproic acid (51 patients) or an equivalent volume of placebo (52 patients). In a subset of these patients (14 epsilon-aminocaproic acid, 12 placebo), tests of platelet function and fibrinolysis were performed.


RESULTS
By multivariate analysis, three factors were associated with decreased blood loss in the first 24 hours after operation: epsilon-aminocaproic acid versus placebo (647 ml versus 839 ml, p = 0.004), surgeon 1 versus all other surgeons (582 ml versus 978 ml, p = 0.002), and no intraaortic balloon versus intraaortic balloon pump use (664 ml versus 1410 ml, p = 0.02). No significant differences in platelet function could be demonstrated between the two groups. Inhibited fibrinolysis, as reflected by less depression of the euglobulin clot lysis and no rise in D-dimer levels, was significant in the epsilon-aminocaproic acid group compared with the placebo group.


CONCLUSIONS
The intraoperative use of epsilon-aminocaproic acid reduces postoperative cardiac surgical bleeding.
Vander Salm
T J
TJ
Division of Cardiothoracic Surgery, University of Massachusetts Medical Center, Worcester 01655-0333, USA.
Kaur
S
S
Lancey
R A
RA
Okike
O N
ON
Pezzella
A T
AT
Stahl
R F
RF
Leone
L
L
Li
J M
JM
Valeri
C R
CR
Michelson
A D
AD
D015119:Aminocaproic Acid / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001792:Blood Platelets / Q000737:chemistry; D006348:Cardiac Surgical Procedures; D004311:Double-Blind Method; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011292:Premedication; D011446:Prospective Studies
D000933:Antifibrinolytic Agents; D019007:P-Selectin; D015119:Aminocaproic Acid