Hemostatic effects of aprotinin, tranexamic acid and epsilon-aminocaproic acid in primary cardiac surgery.
BACKGROUND
The effects of epsilon-aminocaproic acid (EACA) and tranexamic acid (TA) on bleeding and allogeneic transfusions, and the cost of pharmacological and transfusional treatment were compared to aprotinin (AP).


METHODS
We randomized 210 patients subjected to elective cardiac surgery. Of these, 68 patients received EACA (a bolus of 5 g, an infusion of 2 g/h, and 2.5 g in the priming), 72 patients received TA (a bolus of 1 g, an infusion of 400 mg/h, and 500 mg in the priming), and 70 patients received AP (a bolus of 280 mg, an infusion of 70 mg/h, and 280 mg in the priming). Postoperative blood loss and homologous transfusions were collected and the cost of pharmacological treatment and homologous transfusions were calculated.


RESULTS
Bleeding but not allogeneic transfusions was significantly higher in the EACA group (467+/-234 versus TA, 311+/-231 versus AP, 283+/-233; p < 0.001). Costs of pharmacological and transfusional treatment were significantly lower in the TA group ($58.10+/-$105.10) versus the EACA group ($100.70+/-$158.60) versus the AP group ($432.60+/-$118.70) (p < 0.0001).


CONCLUSIONS
Compared to AP, TA has the same effects on bleeding and transfusions, but with a significant reduction of costs. Patients treated with EACA showed a significantly higher postoperative bleeding with an increased trend of transfusion requirement.
Casati
V
V
Department of Cardiothoracic Anesthesia, University of Milan, San Raffaele Hospital, Italy. casati.valter@hsr.it
Guzzon
D
D
Oppizzi
M
M
Cossolini
M
M
Torri
G
G
Calori
G
G
Alfieri
O
O
D015119:Aminocaproic Acid / Q000191:economics / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000191:economics / Q000627:therapeutic use; D007611:Aprotinin / Q000191:economics / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000191:economics; D006348:Cardiac Surgical Procedures; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006490:Hemostatics / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014148:Tranexamic Acid / Q000191:economics / Q000627:therapeutic use
D000933:Antifibrinolytic Agents; D006490:Hemostatics; D014148:Tranexamic Acid; D007611:Aprotinin; D015119:Aminocaproic Acid