title: Aminocaproic acid for the management of bleeding in patients on extracorporeal membrane oxygenation: Four adult case reports and a review of the literature.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) is associated with a significant risk of bleeding and thrombosis. Despite high rates of bleeding and bleeding-related mortality in patients on ECMO, there is little evidence available to guide clinicians in the management of ECMO-associated bleeding.
  
  
  METHODS
  We report the use of aminocaproic acid in four patients with bleeding on ECMO and a review of the literature.
  
  
  RESULTS
  High D-dimer levels and low fibrinogen levels suggested that an antifibrinolytic agent may be effective as an adjunct to control bleeding. After aminocaproic acid administration, bleeding was controlled in each patient as evidenced by clinical and laboratory parameters. One patient suffered a cardiac arrest and care was withdrawn.
  
  
  CONCLUSIONS
  In patients on ECMO with evidence of fibrinolysis, aminocaproic acid may be an effective option to control bleeding and to stabilize clot formation.
authors.affiliation: Department of Pharmacotherapy and Outcomes Science, VCU Pauley Heart Center, Victoria Johnson Research Laboratories, Virginia Commonwealth University, 1200 E Broad Street, West Hospital Rm 520, Richmond, VA 23298, USA. Electronic address: LBuckley2@vcu.edu.
authors.forename: Leo F
authors.initials: LF
authors.lastname: Buckley
authors.affiliation: Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Reardon
authors.affiliation: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Phillip C
authors.initials: PC
authors.lastname: Camp
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Gerald L
authors.initials: GL
authors.lastname: Weinhouse
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Silver
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Couper
authors.affiliation: Hematology Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Connors
mesh_terms: D000328:Adult; D015119:Aminocaproic Acid / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006470:Hemorrhage / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D015119:Aminocaproic Acid
keywords: Aminocaproic acid; Antifibrinolytic agents; Extracorporeal membrane oxygenation; Hemorrhage; Hemostasis