Epsilon-aminocaproic acid administration and stroke following coronary artery bypass graft surgery.
BACKGROUND
Epsilon-aminocaproic acid is routinely used to reduce bleeding during cardiac surgery. Anecdotal reports of thrombotic complications have led to speculation regarding this drug's safety. We investigated the association between epsilon-aminocaproic acid administration and postoperative stroke.


METHODS
Six thousand two hundred ninety-eight patients undergoing isolated coronary artery bypass graft surgery between 1989 and 1995 were studied. Data was obtained from the Duke Cardiovascular Database as well as from an automated intraoperative anesthesia record keeper. Patients identified as having postoperative stroke were reviewed and confirmed by a board certified neurologist blinded to epsilon-aminocaproic acid administration.


RESULTS
Postoperative stroke occurred in 97 patients (1.5%). Three thousand one hundred thirty-five (49.8%) patients received epsilon-aminocaproic acid. Increased age was associated with a higher incidence of postoperative stroke (p = 0.0001). In contrast, there was no significant difference (p = 0.7370) in the incidence of stroke between use of epsilon-aminocaproic acid (1.3%) and nonuse (1.7%). Multivariable logistic regression found no significant effect of epsilon-aminocaproic acid use on stroke after accounting for age, date of surgery, and history of diabetes.


CONCLUSIONS
This series suggests that epsilon-aminocaproic acid administration does not increase the risk of postoperative stroke.
Bennett-Guerrero
E
E
Department of Anesthesiology, The Mount Sinai Medical Center, New York, New York 10029-6574, USA. elliott_guerrero@smtplink.mssm.edu
Spillane
W F
WF
White
W D
WD
Muhlbaier
L H
LH
Gall
S A
SA
Smith
P K
PK
Newman
M F
MF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000614:Aminocaproates / Q000627:therapeutic use*; D002561:Cerebrovascular Disorders / Q000209:etiology*; D001026:Coronary Artery Bypass; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors
D000614:Aminocaproates