Comparison of epsilon aminocaproic acid and tranexamic acid in pediatric cardiac surgery

OBJECTIVE: This study compared the efficacy of aminocaproic acid and tranexamic acid in reducing postoperative blood loss, as well as blood and blood product requirements in children with cyanotic congenital heart disease. DESIGN: A prospective randomized study. SETTING: Cardiac center of a tertiary care, referral hospital. PARTICIPANTS: One hundred fifty children in the age group of 2 months to 14.5 years with cyanotic congenital heart disease undergoing corrective surgery on cardiopulmonary bypass (CPB). INTERVENTIONS: Patients were randomized into 3 groups. Group A was given aminocaproic acid in a dose of 100 mg/kg after anesthetic induction, 100 mg/kg on CPB and 100 mg/kg after protamine. Group T was given tranexamic acid, 10 mg/kg, after anesthetic induction, 10 mg/kg on CPB, and 10 mg/kg after protamine. Group C was the control group. MAIN RESULT: Control group had the longest sternal closure time, maximum blood loss at 24 hours, and maximum requirements of blood and blood products. Among the 2 groups given antifibrinolytics, there was no significant difference in postoperative blood loss, blood and product requirement, and reexploration rates. CONCLUSION: Aminocaproic acid and tranexamic acid are equally effective in reducing postoperative blood loss, as well as blood and blood product requirements in children with cyanotic heart disease undergoing corrective surgery as compared with the control group.     

Carcinoma of bladder masked by epsilon aminocaproic acid therapy

Uncontrolled EACA (epsilon aminocaproic acid) therapy for hematuria was responsible for the formation of an insoluble fibrin cast within the bladder. The causefo the bleeding was found to be unsuspected carcinoma of the bladder. Repeated and thorough urologic investigation is mandatory in all instances of continued hematuria, and therapy with EACA is contraindicated unless a specific fibrinolytic defect is proved.     

The mechanism of hepatoprotection by epsilon aminocaproic acid and putrescine

Hepatic neutral serine proteases (including plasminogen activator) and ornithine decarboxylase (ODC) are induced by the hepatotoxin galactosamine (GALN). We examined the hepatoprotection conferred by epsilon-aminocaproic acid (EACA), a fibrinolytic inhibitor, putrescine (PUTR), the polyamine generated from ornithine by ODC, and alpha-difluoromethylornithine (DFMO), an irreversible inhibitor of ODC. GALN, 450 mg/kg, was administered intraperitoneally to Wistar-Lewis rats (group I). Groups II, III, and IV were also given EACA (80 mg/kg), PUTR (0.3 mmol/kg), or DFMO (0.3 mmol/kg), respectively, 1 hour before and 3, 7, and 12 hours after GALN. Rats were killed 2 hours after an intraperitoneal dose of 3H-thymidine was administered, 30 or 45 hours after GALN. EACA and PUTR were effective protectants against necrosis as judged by enzymes and histologic findings. Neither increased thymidine incorporation above the levels seen with GALN only. DFMO offered no protection even though thymidine incorporation at 45 hours was increased. Both EACA and PUTR, which have similar chemical structures, possessed significant antiprotease activity in vitro, suggesting that they act by inhibiting toxin-induced neutral serine protease activity and not by accelerating regeneration.     

Efficacy of aprotinin, epsilon aminocaproic acid, or combination in cyanotic heart disease

BACKGROUND: Aprotinin and epsilon aminocaproic acid are antifibrinolytic agents used to reduce postoperative blood loss after cardiopulmonary bypass. We compared low dose aprotinin with epsilon aminocaproic acid and a combination of the two agents to reduce postoperative blood loss in infants with congenital cyanotic heart disease undergoing corrective surgical procedures. METHODS: This prospective study was conducted randomly on 300 children. Group I (n = 80) acted as the control and did not receive either of the study drugs. Group II (n = 100) received low dose aprotinin, group III (n = 60) received epsilon aminocaproic acid, and group IV (n = 60) received a combination of the two antifibrinolytic agents. RESULTS: The control group had the longest time for sternal closure, maximum blood loss at 24 hours, and greatest requirements for packed red blood cells and platelets. Fibrinogen levels were significantly lower, and levels of fibrin breakdown products were significantly higher compared with the groups given either or both of the antifibrinolytics. CONCLUSIONS: Epsilon aminocaproic acid is as efficacious as low dose aprotinin in reducing postoperative blood loss and packed red blood cell and platelet requirements in children with congenital cyanotic heart disease. The combination of the two was slightly more effective.     

Intravesical epsilon aminocaproic acid in management of intractable bladder hemorrhage.

Thirty-seven patients with intractable bladder hemorrhage were treated with intravesical epsilon aminocaproic acid (EACA). Radiation cystitis and cyclophosphamide-induced cystitis were the two most common causes of intractable bladder hemorrhage. Thirty-four patients responded to treatment. No side effects were noted. Intravesical EACA appears to be a safe and effective method to control intractable bladder hemorrhage.     

Comparison of epsilon aminocaproic acid and low-dose aprotinin in cardiopulmonary bypass: efficiency, safety and cost

BACKGROUND: In this study we compared the clinical efficiency, safety, and economic benefit of low-dose aprotinin with epsilon aminocaproic acid (EACA) in reducing bleeding after cardiopulmonary bypass operation. METHODS: In a double-blind, randomized study, 100 patients received low-dose aprotinin (2 x 10(6) kallikrein inhibitor units) or EACA (20 g). The surgical procedure was single- or double-valve replacement with or without coronary artery bypass grafts. RESULTS: Mediastinal chest drainage and transfusion requirements with both therapies were similar. There were no urgent reoperations to secure hemostasis in either group. Similar levels of D-dimer with both therapies indicate a similar inhibition of fibrinolysis. Release of troponin I was less in the low-dose aprotinin group 1 and 4 hours after bypass, although electrocardiographic measurements did not reflect this difference. Levels of S-100beta and neuron-specific enolase were similar with both therapies, confirming that there was no difference in the occurrence of any adverse neurologic events in either group. CONCLUSIONS: Low-dose aprotinin and EACA showed similar effects on the reduction of intraoperative and postoperative bleeding. The lower cost of EACA with no change in safety outcome suggests it is the preferred treatment.     

Epsilon aminocaproic acid and the control of post-prostatectomy bleeding: a prospective double-blind study

We randomized 61 patients undergoing transurethral resection of the prostate in a double-blind parallel fashion to receive epsilon aminocaproic acid or an equivalent volume of placebo solution immediately after the operation. All blood loss during the first 72 hours postoperatively was monitored. Four patients were nonevaluable . The use of epsilon aminocaproic acid caused no significant complication or side effect. There was no significant difference in regard to blood loss, hospital stay or days on catheter drainage between the 2 groups. We conclude that the routine use of epsilon aminocaproic acid after transurethral resection of the prostate is not warranted.     

Use of epsilon aminocaproic acid (EACA) in the preoperative management of ruptured intracranial aneurysms.

The authors report their experience with the use of epsilon aminocaproic acid (EACA) in the preoperative management of a series of patients with ruptured intracranial aneurysms. A similar series of patients was taken as control. They found that EACA is of definite value in preventing recurrent hemorrhage in the preoperative period. The significance of antifibrinolytic therapy in ruptured intracranial aneurysms is discussed.     

The effects of epsilon aminocaproic acid on contractile properties and catecholamine content of rat carotid arteries

The prevalent use of epsilon aminocaproic acid (EACA) to prevent rebleeding in the preoperative management of ruptured intracranial aneurysms raises the question of a relationship between this drug and cerebral vasospasm. The effects of EACA on the contractile properties of the rat common carotid artery were measured in vitro, and the effects of EACA on the catecholamine content of these arteries were determined qualitatively. When carotid artery segments from rats that had been infused with lactated Ringer's solution alone were incubated in the presence of 1 mM EACA, they exhibited a decrease in contractile activity brought about by the presence of either serotonin or norepinephrine, and an increase in contractile activity when potassium chloride was used. These changes were not witnessed if the arterial segments came from rats that had been infused with lactated Ringer's solution containing EACA. No effect of epsilon aminocaproic acid was found on the median effective dose values for each vasoconstrictor used. Fluorescence histochemistry showed no qualitative changes in the catecholamine content of carotid arteries following EACA treatment.     

Safety and efficacy of intravesical aminocaproic acid for bleeding after transurethral resection of prostate

There appears to be no clinically significant difference in blood loss or transfusion requirements after transurethral resection of the prostate (TURP) when intravesical 0.5% aminocaproic acid is compared with 0.9% sodium chloride irrigation in patients during the first three days after surgery. This is probably because early post-TURP bleeding is due to inadequate hemostasis or perforation of the prostatic capsule, and not excessive local or systemic fibrinolysis. However, we suggest that intravesical aminocaproic acid might be a useful alternative to systemic antifibrinolytic therapy in patients with delayed, recurrent, excessive post-prostatectomy bleeding, which is thought to be due to fibrinolysis. Since aminocaproic acid is not systemically absorbed after bladder instillation, intravesical administration causes few side effects and does not necessitate screening patients for disseminated intravascular coagulation prior to treatment.     

Control of bleeding in upper urinary tract and retroperitoneal surgery

Surgery of the upper urinary tract and the retroperitoneal spaces is a constant invitation to potentially serious bleeding. An adequate well-organized exposure of the pathologic condition involved, detailed knowledge of the regional anatomy and its variations, careful gentle dissection of the major vessels, and a calm disposition of the surgeon are the critical factors in preventing intraoperative hemorrhage. Unexpected bleeding is at times unavoidable, and the urologic surgeon should have a well-prepared method for managing hemorrhage during each procedure. Temporary control with gauze packs, sponge sticks, or the surgeon's finger should be the initial step in the control of serious hemorrhage, and this will virtually stop most bleeding. The subsequent period should be used to communicate with the anesthesiologist, who must replace the blood already lost and forewarn the blood bank of future needs. The surgeon is obligated to improve exposure of the bleeding site, dissect out the vessel involved, obtain any additional necessary lighting and suction equipment, and call for a colleague to help secure the vascular rent while applying continued proximal and distal tamponade. Because serious intra-operative hemorrhage can be encountered by even the most skilled surgeon, consultation with an experienced colleague should be looked on as an integral part of the armamentarium for the optimal care of the urologic patient.