Epsilon aminocaproic acid reduces blood transfusion and improves the coagulation test after pediatric open-heart surgery: a meta-analysis of 5 clinical trials.
BACKGROUND
Excessive postoperative blood loss after cardiopulmonary bypass is a common problem, especially in patients suffering from congenital heart diseases. The efficacy of epsilon aminocaproic acid (EACA) as a prophylactic treatment for postoperative bleeding after pediatric open-heart surgery has not been determined. This meta-analysis investigates the efficacy of EACA in the minimization of bleeding and blood transfusion and the maintenance of coagulation tests after pediatric open-heart surgery.


METHODS
A comprehensive literature search was performed to identify all randomized clinical trials on the subject. PubMed, Embase, the Cochrane Library, and the Chinese Medical Journal Network were screened. The primary outcome used for the analysis was postoperative blood loss. Secondary outcomes included postoperative blood transfusion, re-exploration rate and postoperative coagulation tests. The mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) were used as summary statistics.


RESULTS
Five trials were included in this meta-analysis of 515 patients. Prophylactic EACA was associated with a reduction in postoperative blood loss, but this difference did not reach statistical significance (MD: -7.08; 95% CI: -16.11 to 1.95; P = 0.12). Patients treated with EACA received fewer postoperative blood transfusions, including packed red blood cells (MD: -8.36; 95% CI: -12.63 to -4.09; P = 0.0001), fresh frozen plasma (MD: -3.85; 95% CI: -5.63 to -2.08; P < 0.0001), and platelet concentrate (MD: -10.66; 95% CI: -18.45 to -2.87; P = 0.007), and had a lower re-exploration rate (RR: 0.46; 95% CI: 0.23 to 0.92; P = 0.03). Prophylactic EACA also improved coagulation tests 6 hours after open-heart surgery.


CONCLUSIONS
Prophylactic EACA minimizes postoperative blood transfusion and helps maintain coagulation in pediatric patients undergoing open-heart surgery. Therefore, the results of this study indicate that adjunctive EACA is a good choice for the prevention of postoperative blood transfusion following pediatric cardiac surgery.
Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine Shanghai, China.
Jun
J
Lu
First Clinical Medical College of Nanjing Medical University Nanjing, China.
Haoyu
H
Meng
Department of Surgery, Xinyi People's Hospital Xinyi, China.
Zhaoyi
Z
Meng
First Clinical Medical College of Nanjing Medical University Nanjing, China.
Ying
Y
Sun
Department of Surgery, University of Pittsburgh Medical Center Pittsburgh, PA, USA.
John P
JP
Pribis
Department of Surgery, University of Pittsburgh Medical Center Pittsburgh, PA, USA.
Chunyan
C
Zhu
Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine Shanghai, China.
Quan
Q
Li
D000293:Adolescent; D000367:Age Factors; D015119:Aminocaproic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control*; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000933:Antifibrinolytic Agents; D015119:Aminocaproic Acid
EACA; Epsilon aminocaproic acid; bleeding; blood transfusion; cardiac surgery; open-heart surgery; pediatric