Can epsilon-aminocaproic acid balance the off-pump bleeding advantage?
BACKGROUND
Aprotinin improved the control of bleeding in patients undergoing surgery with cardiopulmunary bypass, but its use was halted because of the risk of bovine spongiform encephalopathy. We then started to use epsilon-aminocaproic acid and the results in the control of bleeding were satisfactory. To assess its effectiveness in the control of postoperative bleeding precisely, we compared the results for patients operated on for myocardial revascularization on-pump and treated with epsilon-aminocaproic acid with those for patients who decidedly bleed less: off-pump patients.


METHODS
Two groups of patients who had had either on- or off-pump double aortocoronary bypass surgery were retrospectively reviewed for postoperative bleeding. These two almost homogeneous group had two grafts only: left anterior descending and circumflex arteries operated on with cardiopulmonary bypass and treated with the epsilon-aminocaproic acid, and left anterior descending and right coronary arteries operated on off-pump.


RESULTS
Postoperative bleeding through chest drainage at 4 h was 265+/-91.7 mL in the off-pump group and 328.4+/-131.4 mL in the on-pump group (p=0.004). But at 24 h it was 671.6+/-311.5 mL in the off-pump group and 827.8+/-514.4 mL in the on-pump group (p=0.07).


CONCLUSIONS
epsilon-Aminocaproic acid is effective in controlling postoperative bleeding in patients operated on for myocardial revascularization with the aid of cardiopulmonary bypass.
Stassano
P
P
Department of Cardiac Surgery, Medical School, University Federico II, Naples, Italy. pstassano@libero.it
Musumeci
A
A
Santise
G
G
Gagliardi
C
C
Montalto
A
A
Spampinato
N
N
D000368:Aged; D015119:Aminocaproic Acid / Q000627:therapeutic use*; D001243:Assisted Circulation; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
D006490:Hemostatics; D015119:Aminocaproic Acid