title: The effect of prophylactic epsilon-aminocaproic acid on bleeding, transfusions, platelet function, and fibrinolysis during coronary artery bypass grafting.
abstract: BACKGROUND
  Antifibrinolytic medications administered before skin incision decrease bleeding after cardiac surgery. Numerous case reports indicate thrombus formation with administration of epsilon-aminocaproic acid (epsilon-ACA). The purpose of this study was to examine the efficacy of epsilon-ACA administered after heparinization but before cardiopulmonary bypass in reducing bleeding and transfusion requirements after primary coronary artery bypass surgery.
  
  
  METHODS
  Seventy-four adult patients undergoing primary coronary artery bypass surgery were randomized to receive 125 mg/kg epsilon-ACA followed by an infusion of 12.5 mg x kg(-1) x h(-1) or an equivalent volume of saline. Coagulation studies, thromboelastography, and platelet aggregation tests were performed preoperatively, after bypass, and on the first postoperative day. Mediastinal drainage was recorded during the 24 h after surgery. Homologous blood transfusion triggers were predefined and transfusion amounts were recorded.
  
  
  RESULTS
  One patient was excluded for surgical bleeding and five patients were excluded for transfusion against predefined criteria One patient died from a dysrhythmia 2 h postoperatively. Among the remaining 67, the epsilon-ACA group had less mediastinal blood loss during the 24 h after surgery, 529+/-241 ml versus 691+/-286 ml (mean +/- SD), P < 0.05, despite longer cardiopulmonary bypass times and lower platelet counts, P < 0.05. Platelet aggregation was reduced in both groups following cardiopulmonary bypass but did not differ between groups. Homologous blood transfusion was similar between both groups.
  
  
  CONCLUSIONS
  Prophylactic administration of epsilon-ACA after heparinization but before cardiopulmonary bypass is of minimal benefit for reducing blood loss postoperatively in patients undergoing primary coronary artery bypass grafting.
authors.affiliation: Department of Anesthesiology, The Mercy Hospital of Pittsburgh, Pennsylvania 15219, USA. ctroianos@mercy.pmhs.org
authors.forename: C A
authors.initials: CA
authors.lastname: Troianos
authors.forename: R W
authors.initials: RW
authors.lastname: Sypula
authors.forename: D M
authors.initials: DM
authors.lastname: Lucas
authors.forename: F
authors.initials: F
authors.lastname: D'Amico
authors.forename: T B
authors.initials: TB
authors.lastname: Mathie
authors.forename: M
authors.initials: M
authors.lastname: Desai
authors.forename: R T
authors.initials: RT
authors.lastname: Pasqual
authors.forename: R V
authors.initials: RV
authors.lastname: Pellegrini
authors.forename: M L
authors.initials: ML
authors.lastname: Newfeld
mesh_terms: D000328:Adult; D000368:Aged; D015119:Aminocaproic Acid / Q000494:pharmacology*; D000933:Antifibrinolytic Agents / Q000494:pharmacology*; D001792:Blood Platelets / Q000187:drug effects* / Q000502:physiology; D001803:Blood Transfusion; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*
chemical_list: D000933:Antifibrinolytic Agents; D015119:Aminocaproic Acid