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

摘要

Excessive postoperative bleeding after heart operations continues to be a source of morbidity. This double blind prospective study evaluates epsilon- aminocaproic acid (EACA) as an agent to reduce postoperative bleeding: and investigates its mode of action. One hundred three patients were randomly assigned to receive either 30 g. of EACA(51 patients) or an equivalent volume of placebo (52 patients). In a subset of these patients (14 EACA, 12 placebo), tests of platelet function and fibrinolysis were performed. By multivariate analysis, three factors were associated with decreased blood loss in the first 24 hours postoperatively: EACA vs. placebo (647 ml vs 839 ml, p = 0.004): surgeon 1 vs all other surgeons (582 ml vs 978 ml, p = 0.002); and no intraaortic balloon (IABP) vs IABP use (664 ml vs 1410 ml. p = 0.02). No significant difference in platelet function between the two groups could be demonstrated. Fibrinolysis, as reflected in the EACA group by less depression of the euglobulin clot lysis and no rise in D-dimer levels was significantly inhibited when compared to the placebo group. The intraoperative use of EACA reduces postoperative cardiac surgical bleeding.