A comparison of aminocaproic acid and tranexamic acid in adult cardiac surgery.
We compared Aminocaproic acid with tranexamic acid, prospectively in 120 patients undergoing coronary artery bypass surgery on cardiopulmonary bypass. Patients were assigned to one of the 3 groups. Group A (n=40) did not receive any drug and acted as the control group. Group B (n=4) received aminocaproic acid 100 mg/kg each at anaesthetic induction, on bypass and after protamine reversal of heparin. group C (n=40) received tranexamic acid 10 mg/kg each at anaesthetic induction, on bypass and after protamine reversal of heparin. Postoperative blood loss at 24 hours, blood and blood product usage, and re-exploration rates were recorded, and tests for coagulation were performed at 6 hours postoperatively. It was found that blood loss in group A at 24 hours (780+/-120 mL) was significantly greater than Group B (360+/-90 mL) and Group C (215+/-70 mL). Plasma and platelet concentrate use in Group A (215+/-30 mL and 150+/-30 mL) was greater than Group B (190+/-20 mL and 75+/-30 mL) and Group C (185+/-20 mL and 80+/-30 mL). Re- explorations in Group A, 8/40 (20%) were greater than Group B, 2/40 (5%) and Group C, 2/40 (5%). Coagulation tests revealed better preservation of fibrinogen and lower levels of fibrin degradation products, in group B and C. These two groups were however statistically indistinguishable in respect to all the parameters studied, when compared with each other. It was concluded that both the antifibrinolytic agents in the doses studied were equally effective in reducing postoperative blood loss, blood and blood products usage and re-exploration rates. Coagulation parameters were better preserved as compared to the control group.
Chauhan
Sandeep
S
Department of Cardiac Anaesthasia, All India Institute of Medical Sciences, New Delhi, India. sdeep61@yahoo.com
Gharde
Parag
P
Bisoi
Akshay
A
Kale
Shailaja
S
Kiran
Usha
U