title: epsilon-Aminocaproic acid plasma levels during cardiopulmonary bypass.
abstract: epsilon-Aminocaproic acid (EACA) concentrations achieved during cardiopulmonary bypass (CPB) have not been previously reported. It is unknown whether plasma concentrations reported to inhibit fibrinolysis in vitro (130 microg/mL) are achieved or whether differences in these levels relate to variability in postoperative bleeding. EACA (total intraoperative dose 270 mg/kg) was administered to 27 patients undergoing cardiac reoperation. The plasma EACA concentration was measured by using high-pressure liquid chromatography: 1) 30 min after initiation of drug administration (baseline); 2) 30 min (CPB + 30) after initiation of CPB; 3) 90 min after initiation of CPB. (CPB + 90); and 4) at cardiopulmonary bypass termination (end CPB). Plasma EACA concentrations (microg/mL, min - max, mean +/- SD) were 276-998, 593 +/- 154 at baseline; 147-527, 302 +/- 95 at CPB + 30; 112-500, 314 +/- 100 at CPB + 90; and 84-537, 317 +/- 100 at end CPB. Twenty-four-hour postoperative thoracic drainage and allogeneic red blood cell transfusions were not associated with plasma levels at any time. Although plasma EACA concentrations greater than 130 microg/mL were consistently achieved, we observed a marked variability (more than sixfold) in plasma concentrations and bleeding outcomes despite the use of a weight-based dosing regimen. This variability in drug levels appears to have little relevance to bleeding outcomes, possibly since mean plasma levels exceeded 130 microg/mL during CPB, and nearly all patients (26 of 27) achieved that target level.
authors.affiliation: Department of Anesthesiology, The Mount Sinai Medical Center, New York, New York 10029-6574, USA.
authors.forename: E
authors.initials: E
authors.lastname: Bennett-Guerrero
authors.forename: J G
authors.initials: JG
authors.lastname: Sorohan
authors.forename: A T
authors.initials: AT
authors.lastname: Canada
authors.forename: L
authors.initials: L
authors.lastname: Ayuso
authors.forename: M F
authors.initials: MF
authors.lastname: Newman
authors.forename: J G
authors.initials: JG
authors.lastname: Reves
authors.forename: M G
authors.initials: MG
authors.lastname: Mythen
mesh_terms: D000368:Aged; D015119:Aminocaproic Acid / Q000008:administration & dosage / Q000097:blood*; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000097:blood*; D001835:Body Weight; D002315:Cardiopulmonary Bypass; D015505:Chest Tubes; D002851:Chromatography, High Pressure Liquid; D001026:Coronary Artery Bypass; D004322:Drainage; D017707:Erythrocyte Transfusion; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects; D005500:Follow-Up Studies; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D017063:Outcome Assessment, Health Care; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D012086:Reoperation; D014184:Transplantation, Homologous
chemical_list: D000933:Antifibrinolytic Agents; D015119:Aminocaproic Acid