Epsilon Aminocaproic Acid (EACA) Reduces Transfusion Requirements in Patients with Thrombocytopenic Hemorrhage.

Abstract

EACA is an antifibrinolytic drug that has been used to control hemorrhage by stabilizing thrombus. It has been used in thrombocytopenic patients largely on an empiric basis, based on small case series reports with randomized trials lacking. Use of this drug has been limited secondary to concerns about the side effects. We reviewed our experience with EACA to help determine safety and efficacy. We conducted a computer database search of all patients who were prescribed EACA at the Cleveland Clinic Foundation from 1997 to 2003. We then analyzed patients older than 18 years with hemorrhage and thrombocytopenia of less than 75,000/μl. We excluded patients undergoing prophylactic EACA use during cardiac, urologic or orthopedic surgery. 75 patients were identified. Their median age was 55years (Range 23–84 years). There were 38 Males and 37 Females. Underlying diagnoses included Acute Myelogenous Leukemia (N=35), Myelodysplastic syndrome (N=9), Non Hodgkins Lymphoma (N=9), and others (N=22). 33 had hematopoietic stem cell transplants (24 Allogeneic of whom 19 had Graft Versus Host Disease and 9 Autologous). The source of bleeding included Mucosal membranes (N=30), Gastrointestinal (N=27), Genitourinary (N=5), Pulmonary (N=4), Uterine (N=3), Venous catheter associated (N=3) and Central Nervous System (N=3). Alloimmunization or refractoriness to platelet transfusion was identified in 32 (43%) patients. The median platelet count at the initiation of EACA was 6,000/μl (Range 1,000–62,000/μl), the median duration of EACA administration was 10 days (Range 1–216 days), the median average dose was 6 grams/day (Range 2–24 grams/day). Bleeding completely stopped in 50 patients (67%), decreased in 13 (17%) and did not stop in 12 (16%). Red blood cell transfusions were decreased in 46(61%) patients. Prior to EACA, patients were on an average receiving 1.6 +/− 0.7 platelet unit transfusions per day (Range 0–3 Units/day). Subsequent to EACA, patients received 1.0 +/− 0.7 transfusions per day for the duration of time they received EACA (Range 0–3 Units/day). The average decrease in daily transfusion needs was 0.5 +/− 0.6 units (median 0.5 units, range 0.2–3 unit decrease. p<0.001). Adverse events attributable to EACA included worsening of liver function tests in 5 patients (All with underlying GVHD), genitourinary clots requiring discontinuation of the drug in 3 patients, cardiac arrhythmia in 2 patients (Atrial Fibrillation & sinus bradycardia), and elevated creatinine in 1 patient. Neither Disseminated intravascular coagulation (DIC) nor Deep venous Thrombosis (DVT) was observed while on the drug. We conclude that EACA is an effective drug in the treatment of thrombocytopenic hemorrhage with an overall response rate of 84%. EACA reduces transfusion requirements with manageable side effects. Further study of EACA is warranted as a treatment for thrombocytopenic hemorrhage.