Comparison of epsilon aminocaproic acid and tranexamic Acid in thoracic aortic surgery: clinical efficacy and safety.
OBJECTIVE
To evaluate the efficacy and safety of tranexamic acid (TXA) versus epsilon aminocaproic acid (EACA) in patients undergoing thoracic aortic surgery.


METHODS
A prospective randomized study.


METHODS
A tertiary care center.


METHODS
The study was conducted on 64 consecutive adult patients undergoing thoracic aortic surgery with cardiopulmonary bypass (CPB).


METHODS
Group EACA received a bolus of 50 mg/kg of EACA after induction of anesthesia over 20 minutes followed by maintenance infusion of 25 mg/kg/h until chest closure. Group TXA received a bolus of 10 mg/kg of TXA after induction of anesthesia over 20 minutes followed by maintenance infusion of 1 mg/kg/h until chest closure.


RESULTS
Cumulated mean blood loss, total packed red blood cells, and blood product requirement up to 24 h postoperatively were comparable between groups. A significant renal injury (EACA 40% v TXA 16%; p = 0.04) and increased tendency for renal failure (EACA 10% v TXA 0%, p = 0.11; relative risk 2.15) were observed with EACA compared to TXA. There was increased tendency of seizure with TXA (EACA v TXA: 3.3% v 10%; p>0.05, relative risk 1.53). There was significant increase in the D-dimer from preoperative to postoperative values in Group EACA. (p< 0.01).


CONCLUSIONS
Both EACA and TXA were equally effective in reducing the perioperative blood loss and transfusion requirement in patients undergoing thoracic aortic surgery. While significant renal injury was observed with EACA, there was a tendency for higher incidence of seizure with TXA. Prospective placebo-controlled trials recruiting larger sample size using sensitive biomarkers are required before any recommendations.
Departments of Cardiac Anaesthesia. Electronic address: neetimakhija@hotmail.com.
Neeti
N
Makhija
Anju
A
Sarupria
Shiv
S
Kumar Choudhary
Sambhunath
S
Das
Ramakrishnan
R
Lakshmy
Usha
U
Kiran
D000328:Adult; D015119:Aminocaproic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001013:Aorta, Thoracic / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000453:epidemiology / Q000209:etiology; D018401:Sample Size; D014148:Tranexamic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000401:mortality
D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D014148:Tranexamic Acid; D015119:Aminocaproic Acid
cardiopulmonary bypass; epsilon aminocaproic acid; postoperative bleeding; postoperative blood loss; thoracic aortic surgery; tranexamic acid