Reduction of Bleeding After Heart Operations Through the Prophylactic Use of Epsilon-Aminocaproic Acid

J Thorac Cardiovasc Surg. 1996 Oct;112(4):1098-107. doi: 10.1016/S0022-5223(96)70112-5.

Abstract

Excessive postoperative bleeding after heart operations continues to be a source of morbidity. This prospective double-blind study evaluated epsilon-aminocaproic acid as an agent to reduce postoperative bleeding and investigated its mode of action. One hundred three patients were randomly assigned to receive either 30 gm epsilon-aminocaproic acid (51 patients) or an equivalent volume of placebo (52 patients). In a subset of these patients (14 epsilon-aminocaproic acid, 12 placebo), tests of platelet function and fibrinolysis were performed.

Results: By multivariate analysis, three factors were associated with decreased blood loss in the first 24 hours after operation: epsilon-aminocaproic acid versus placebo (647 ml versus 839 ml, p = 0.004), surgeon 1 versus all other surgeons (582 ml versus 978 ml, p = 0.002), and no intraaortic balloon versus intraaortic balloon pump use (664 ml versus 1410 ml, p = 0.02). No significant differences in platelet function could be demonstrated between the two groups. Inhibited fibrinolysis, as reflected by less depression of the euglobulin clot lysis and no rise in D-dimer levels, was significant in the epsilon-aminocaproic acid group compared with the placebo group.

Conclusion: The intraoperative use of epsilon-aminocaproic acid reduces postoperative cardiac surgical bleeding.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Aminocaproic Acid / therapeutic use*
  • Antifibrinolytic Agents / therapeutic use*
  • Blood Platelets / chemistry
  • Cardiac Surgical Procedures*
  • Double-Blind Method
  • Female
  • Fibrinolysis / drug effects
  • Humans
  • Intra-Aortic Balloon Pumping
  • Male
  • Middle Aged
  • P-Selectin / blood
  • Postoperative Hemorrhage / prevention & control*
  • Premedication*
  • Prospective Studies

Substances

  • Antifibrinolytic Agents
  • P-Selectin
  • Aminocaproic Acid