Efficacy of ϵ-aminocaproic acid in children undergoing cardiac surgery

Abstract

Objective: To compare coagulation test results, blood loss, and blood product transfusions between patients receiving prophylactic ϵ-aminocaproic acid (EACA) and a control group matched for age, resternotomy, and surgery in children undergoing cardiac surgery. Design: Nested case-control study. Setting: University-affiliated, pediatric medical center. Participants: Same study period; 70 patients in EACA group and 70 patients in control group. Interventions: Prophylactic EACA administered intravenously (load, 150 mg/kg, infusion; 30 mg/kg/h) to 70 patients at increased risk for bleeding (reoperation or Ross procedure). Measurements and Main Results: Coagulation test values were measured before, during, and after cardiopulmonary bypass (CPB). Intraoperative blood loss, postoperative chest tube output, and allogenic blood product transfusions were recorded. Comparison of demographic and surgical data indicated close matching of the EACA and control groups. The EACA group ((median, 25th to 75th quartile] 15.6 mL/kg; 9.2 to 26.3 mL/kg) had less intraoperative blood loss than the control group (22.2 mL/kg; 14.3 to 36.3 mL/kg; p = 0.02). Postoperative chest tube output at 6 hours ( p = 0.08), 12 hours ( p = 0.07), and 24 hours ( p = 0.08) was not significantly different between groups. Fewer EACA group patients required reexploration for bleeding ( p < 0.05). There was no difference between groups in blood products transfused (in milliliters per kilogram or allogenic exposure per patient). Thromboelastography values (maximum amplitude [ma], whole blood clot lysis index at 30 minutes after MA) during CPB were better preserved in the EACA group. Conclusion: EACA reduced intraoperative blood loss but did not significantly decrease blood product transfusions. Lack of efficacy may be related to relative underdosing and should be further studied.