Epsilon aminocaproic acid reduces blood transfusion and improves the coagulation test after pediatric open-heart surgery: a meta-analysis of 5 clinical trials

Abstract

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.

Keywords: EACA; Epsilon aminocaproic acid; bleeding; blood transfusion; cardiac surgery; open-heart surgery; pediatric.

Figure 1

Trial selection flow chart. The process used for the selection of relevant randomized clinical trials for inclusion in the current meta-analysis is shown.

Figure 2

Prophylactic EACA and postoperative blood loss. Data are expressed as MD and 95% CI. The size of the data markers (squares) is approximately proportional to the statistical weight of each trial. CI, confidence intervals; EACA, epsilon aminocaproic acid; MD, mean difference.

Figure 3

Prophylactic EACA and blood transfusion. Data are expressed as MD and 95% CI. The following blood transfusion types were assessed: PRBC (top panel), FFP (middle panel), and PC (bottom panel). The size of the data markers (squares) is approximately proportional to the statistical weight of each trial. CI, confidence intervals; EACA, epsilon aminocaproic acid; FFP, fresh frozen plasma; MD, mean difference; PC, platelet concentrate; PRBC, packed red blood cells.

Figure 4

Prophylactic EACA and re-exploration rate. Data are expressed as RR and 95% CI. The size of the data markers (squares) is approximately proportional to the statistical weight of each trial. CI, confidence intervals; EACA, epsilon aminocaproic acid; RR, risk ratio.