Abstract
Antifibrinolytic agents reduce bleeding after cardiac surgery, but there are adverse effects after their systemic use. These effects are avoided by topical application of antifibrinolytic agents in pericardial cavity. We compared the effects of topically applied epsilon-aminocaproic acid (EACA) and placebo on postoperative bleeding and transfusion requirements after coronary artery bypass surgery. In this single center prospective, randomized, double-blind trial, 53 patients were randomized into two groups to receive EACA (24 g in 250 ml of saline solution) or placebo (250 ml of saline solution) before sternal closure. Groups were comparable with respect to all preoperative and intraoperative variables. Postoperative bleeding, transfusion requirements and hematologic parameters were evaluated. Postoperative bleeding within first 24 hours (h) period (EACA group 154.66+/-74.64 x Placebo group 220.21+/-136.42 ml; P=0.031) showed statistically significant inter-group difference, within 48 h (EACA group 259.14+/-420.07 x Placebo group 141.67+/-142.58 ml; P=0.614), as well as cumulative blood loss (EACA group 832.07+/-576.86 x Placebo group 827.50+/-434.12 ml; P=0.975), not showed statistically inter-group differences. Inter-group difference of blood product requirements was statistically significant (EACA group 185.90+/-342.07 x Placebo group 439.42+/-349.07 ml; P=0.016). Laboratory analyses showed no differences between the two groups postoperative (hematologic characteristics: hemoglobin (g/dl)- EACA group 9.18+/-0.92 x Placebo group 8.85+/-1.48 g/dL; P=0.11; hematocrit (%)-EACA group 28.15+/-3.35 x Placebo group 26.67+/-4.15%; P=0.06). Topical use of epsilon aminocaproic acid reduces postoperative bleeding in the first 24 hours and requirements of blood transfusion after coronary artery bypass graft surgery.
Highlights
The systemic use of antifibrinolytic agents remains controversial, with conflicting evidences in terms of benefits and adverse events [1]
The topical application of tranexamic acid (TA) and aprotinine have already been tested in previous works and, one of the main reasons not to recognize the regular use of these agents is the lack of evidences of their potential benefits [3,4]
In 2007, Baric et al compared the effects of topical application of TA, aprotinine and placebo over postoperative bleeding of 300 patients submitted to cardiac surgery, concluding the benefits in the topical use of antifibrinolytic agents [6]
Summary
The systemic use of antifibrinolytic agents remains controversial, with conflicting evidences in terms of benefits and adverse events [1]. The topical use of these agents, in the pericardial cavity, started to be considered as an alternative for reducing bleeding after cardiovascular surgeries [2,3]. To the systemic use, the topical application of antifibrinolytics in the pericardial cavity is not a routine procedure in cardiac surgeries [4]. The topical application of tranexamic acid (TA) and aprotinine have already been tested in previous works and, one of the main reasons not to recognize the regular use of these agents is the lack of evidences of their potential benefits [3,4]. In 2007, Baric et al compared the effects of topical application of TA, aprotinine and placebo over postoperative bleeding of 300 patients submitted to cardiac surgery, concluding the benefits in the topical use of antifibrinolytic agents [6]
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