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Reduction of bleeding after heart operations through the prophylactic use of epsilon-aminocaproic acid.

Author(s): Vander Salm TJ, Kaur S, Lancey RA, Okike ON, Pezzella AT, Stahl RF, Leone L, Li JM, Valeri CR, Michelson AD

Affiliation(s): Division of Cardiothoracic Surgery, University of Massachusetts Medical Center, Worcester 01655-0333, USA.

Publication date & source: 1996-10, J Thorac Cardiovasc Surg., 112(4):1098-107.

Publication type: Clinical Trial; Randomized Controlled Trial

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.

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