A comparitive study between tranexamic acid and epsilon-amino-caproic acid in reducing post-operative bleeding in patients undergoing on pump cabg surgeries.

Abstract

The amount of strain that cardiac surgery exerts on blood bank services is an example that emphasises the need for multimodel blood conservation stratergy. The most common factor which is being attibutable to increased bleeding after cardiac surgery is hyperfibrinolysis. Thererfore the use of antifibrinolytics during high risk cardiac surgery becomes inevitable. Commonly used antifibrinolytic include Tranexamic Acid(TA) and Epsilon-amino-caproic acid (EACA) .The aim of our study was to compare the effectiveness of both TA and EACA in reducing post surgical bleeding in on-pump CABG surgeries and to asses the post operative complications associated with its use.Material and Methods After obtaining informed written consent,approval of ethics and research commitee patients who were scheduled for on-pump CABG were included in the study.Patients were divided into two groups randomly by using a comupter generated randomized block design namely group TA(n=40) and group EACA (n=40). TA group received tranaxamic acid at a dose of 10mg/kg IV over 20 min at the time of induction then 1-2 mg/kg in CPB prime followed by 1 mg /kg/hr infusion during surgery. Group EACA received EACA in a dose of 100mg/kg/IV over 20 min at he time of induction then 5-10mg/kg in CPB prime followed by 10mg/kg/hr infusion during surgery . Pateints were assessed for blood loss and were monitored for fibrinogen level and D- dimer levels, Re-exploration and post operative complications. Result Primary outcomes like bleeding at 4hrs, there was no significant difference between the groups but when total bleeding at 24 hrs was compared there was a significantly lesser bleed in group TA group compared to group EACA (P=0.0022).The requirement of PRBC in group TA was for 3 patients,where as in EACA group 4 patients required PRBC (P>0.05).There was no significant difference in the rate of post operative complications between the groups.(P>0.05) .Conclusion from our study we concluded that both TA & EACA effectively inhibits fibrinolysis during on pump CABG surgery and thus results in decreased post operative bleeding.When compared between the two, TA was slightly better with respect to post operative bleeding at 24hrs.Our study also re emphesized the fact that neither of the drug led to any additional risk of post operative thrombotic complications.