The Efficacy of Tranexamic Acid Versus Epsilon Amino Caproic Acid in Decreasing Blood Loss in Patients Undergoing Mitral Valve Replacement Surgery

Abstract

Open heart surgeries under cardiopulmonary bypass are associated with excessive perioperative bleeding that often requires re-exploration. Antifibrinolytics like epsilon aminocaproic acid and tranexamic acid are widely used to control bleeding. There is paucity of literature on studies to reduce blood loss and blood transfusion following mitral valve replacement surgeries. The aim of this study was to compare incidence of re-exploration, blood loss and blood transfusion following mitral valve replacement surgeries in patients who were administered either tranexamic acid or epsilon amino caproic acid. However their efficacy has not been studied in mitral valve replacement surgeries. This is a prospective, randomized, double blind study performed among sixty patients of either sex in the age group of 18 to 60 years scheduled for mitral valve replacement surgeries. They were randomly allocated into two groups, Group 1 (TA n=3O) tranexeamic acid 20 mg/kg body weight diluted in 20ml syringe over 20 min as bolus at time of induction of anaesthesia, infusion of 2mg/kg/hr started continued throughout surgery and continued till 6 hour post operatively in recovery room. Group 2 (EACA n=30) epsilon amino caproic acid 100 mg/kg body wt bolus diluted to 20 ml syringe over 20 min as bolus at time of induction of anaesthesia, infusion 20mg/kg/hr started continued throughout surgery and continued till 6 hour post operatively in recovery room. After admission to intensive care unit total blood loss, transfusion requirements during the first 24 hours and other complications were recorded. In our study we found that mean post operative blood loss in tranexamic acid group 416+47.74 (ml) which is lower than epsilon amino caproic acid group 489+42.12 (ml) that is statistically significant. 16 out of 30 patients in TA group i.e. 53.3% patients received transfusion, where as in EACA group 21 out of 30 patients i.e. 70% patients received transfusion. The total transfusion requirements, total donor unit exposure and financial cost of blood components are less in the tranexamic acid group. Prophylactic tranexamic acid effectively reduces perioperative blood loss in mitral valve replacement surgery.