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A randomized, double-blinded trial comparing the effectiveness of tranexamic acid and epsilon-aminocaproic acid in reducing bleeding and transfusion in cardiac surgery


1 Montefiore Medical Center, New York, USA
2 Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, USA
3 Department of Anesthesiology, Montefiore Hospital and Medical Center, New York, USA
4 Department of Anesthesiology, North Shore Long Island Jewish Health System, New York, USA
5 Department of Anesthesiology, Lincoln Medical Center, New York, USA
6 Department of Anesthesiology, Hofstra University, North Shore Long Island Jewish School of Medicine, New York, USA

Correspondence Address:
Singh Nair
Department of Anesthesiology, Montefiore Hospital and Medical Center, Bronx, New York
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_137_18

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Year : 2019  |  Volume : 22  |  Issue : 3  |  Page : 265-272

 

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Objectives: To compare the effectiveness of epsilon aminocaproic acid (EACA) to tranexamic acid (TA) in reducing blood loss and transfusion requirements in patients undergone cardiac surgery under cardiopulmonary bypass. Design: Randomized, double blinded study. Outcome variables collected included; baseline demographic characteristics, type of surgery, amount of 24 hour chest tube drainage, amount of 24 hour blood products administered, 30 day mortality and morbidity and length of stay. We analyzed the data using parametric and non-parametric tests as appropriate. Setting: Single center tertiary-care university hospital setting. Participants: 114 patients who had undergone cardiac surgery under cardiopulmonary bypass. Interventions: Standard dose of intra-operative EACA or TA was compared in patients undergone cardiac surgery under cardiopulmonary bypass. Results: There was no statistically significant difference between groups when analyzing chest tube drainage. However, there was a significant difference in the administration of any transfusion (PRBC's, FFP, platelets) intra-operatively to 24 hours postoperatively, with less transfusion in patients receiving EACA compared to TA (25% vs. 44.8%, respectively P = 0.027). Additionally, there was no significant difference in terms of adverse events during the one month follow up period. Conclusion: The findings of this study suggest that EACA and TA have similar effects on chest tube drainage but EACA is associated with fewer transfusions in CABG alone surgeries. Our results suggest that EACA can be used in a similar fashion to TA which may result in a cost and morbidity advantage.






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1 Montefiore Medical Center, New York, USA
2 Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, USA
3 Department of Anesthesiology, Montefiore Hospital and Medical Center, New York, USA
4 Department of Anesthesiology, North Shore Long Island Jewish Health System, New York, USA
5 Department of Anesthesiology, Lincoln Medical Center, New York, USA
6 Department of Anesthesiology, Hofstra University, North Shore Long Island Jewish School of Medicine, New York, USA

Correspondence Address:
Singh Nair
Department of Anesthesiology, Montefiore Hospital and Medical Center, Bronx, New York
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_137_18

Rights and Permissions

Objectives: To compare the effectiveness of epsilon aminocaproic acid (EACA) to tranexamic acid (TA) in reducing blood loss and transfusion requirements in patients undergone cardiac surgery under cardiopulmonary bypass. Design: Randomized, double blinded study. Outcome variables collected included; baseline demographic characteristics, type of surgery, amount of 24 hour chest tube drainage, amount of 24 hour blood products administered, 30 day mortality and morbidity and length of stay. We analyzed the data using parametric and non-parametric tests as appropriate. Setting: Single center tertiary-care university hospital setting. Participants: 114 patients who had undergone cardiac surgery under cardiopulmonary bypass. Interventions: Standard dose of intra-operative EACA or TA was compared in patients undergone cardiac surgery under cardiopulmonary bypass. Results: There was no statistically significant difference between groups when analyzing chest tube drainage. However, there was a significant difference in the administration of any transfusion (PRBC's, FFP, platelets) intra-operatively to 24 hours postoperatively, with less transfusion in patients receiving EACA compared to TA (25% vs. 44.8%, respectively P = 0.027). Additionally, there was no significant difference in terms of adverse events during the one month follow up period. Conclusion: The findings of this study suggest that EACA and TA have similar effects on chest tube drainage but EACA is associated with fewer transfusions in CABG alone surgeries. Our results suggest that EACA can be used in a similar fashion to TA which may result in a cost and morbidity advantage.






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