330: CHARACTERIZING AMINOCAPROIC ACID USE IN BLEEDING, CRITICALLY ILL, THROMBOCYTOPENIC CANCER PATIENTS

Abstract

Introduction: Thrombocytopenia is common in oncologic patients due to underlying malignancy and complications from treatment. Aminocaproic acid (ACA) is an antifibrinolytic agent that has been used off-label for bleeding associated with thrombocytopenia. Limited evidence exists regarding the efficacy and safety of ACA use in bleeding, critically ill, thrombocytopenic patients. Methods: Single-center, retrospective cohort study of critically ill adult patients with thrombocytopenia and active bleeding at a comprehensive cancer center from January 1, 2018 to December 31, 2020. Thrombocytopenia was defined as platelets < 100,000/mm3 and ICU admission was required at the time of or within 24 hours of ACA initiation. The primary outcome was change in daily packed red blood cell (PRBC) transfusions requirements at 120 hours. Results: Of 202 patients screened, 150 met inclusion criteria. The majority of patients had leukemia (78%) and severe thrombocytopenia (median 16 K/mm3). Pulmonary bleeding was the most common site of bleeding (52%), followed by gastrointestinal (23%). There was a statistically significant decrease in daily PRBC transfusions at 120 hours [-1, range -4 to 2, p< 0.001). There was no significant difference in subgroup analyses with regard to renal function or platelet count. The incidence of thromboembolism within 14 days was 8%, primarily venous thromboses. Conclusions: Among bleeding, critically ill oncology patients with thrombocytopenia, the use of ACA was associated with a statistically significant decrease in daily PRBC transfusion requirements. Thromboembolic events occurred within 14 days and were mostly venous in nature.