Comparison of Epsilon Aminocaproic Acid and Tranexamic Acid in Thoracic Aortic Surgery: Clinical Efficacy and Safety

• Published in: Journal of cardiothoracic and vascular anesthesia 2013-12, Vol.27 (6), p.1201-1207
• Main Authors: Makhija, Neeti, MD, Sarupria, Anju, MD, DM, Kumar Choudhary, Shiv, MS, MCH, Das, Sambhunath, MD, Lakshmy, Ramakrishnan, PhD, Kiran, Usha, MD
• Format: Article
• Language: English
• Subjects: Adult; Aminocaproic Acid - adverse effects; Aminocaproic Acid - therapeutic use; Anesthesia & Perioperative Care; Antifibrinolytic Agents - adverse effects; Antifibrinolytic Agents - therapeutic use; Aorta, Thoracic - surgery; Blood Loss, Surgical - prevention & control; Blood Transfusion - methods; cardiopulmonary bypass; Cardiopulmonary Bypass - methods; Critical Care; epsilon aminocaproic acid; Female; Fibrin Fibrinogen Degradation Products - analysis; Humans; Male; Middle Aged; postoperative bleeding; postoperative blood loss; Postoperative Care; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prospective Studies; Renal Insufficiency - epidemiology; Renal Insufficiency - etiology; Sample Size; thoracic aortic surgery; tranexamic acid; Tranexamic Acid - adverse effects; Tranexamic Acid - therapeutic use; Vascular Surgical Procedures - methods; Vascular Surgical Procedures - mortality
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2013.04.003

Objective To evaluate the efficacy and safety of tranexamic acid (TXA) versus epsilon aminocaproic acid (EACA) in patients undergoing thoracic aortic surgery. Design A prospective randomized study. Setting A tertiary care center. Participant The study was conducted on 64 consecutive adult patients undergoing thoracic aortic surgery with cardiopulmonary bypass (CPB). Interventions Group EACA received a bolus of 50 mg/kg of EACA after induction of anesthesia over 20 minutes followed by maintenance infusion of 25 mg/kg/h until chest closure. Group TXA received a bolus of 10 mg/kg of TXA after induction of anesthesia over 20 minutes followed by maintenance infusion of 1 mg/kg/h until chest closure. Measurements and Main Results Cumulated mean blood loss, total packed red blood cells, and blood product requirement up to 24 h postoperatively were comparable between groups. A significant renal injury (EACA 40% v TXA 16%; p = 0.04) and increased tendency for renal failure (EACA 10% v TXA 0%, p = 0.11; relative risk 2.15) were observed with EACA compared to TXA. There was increased tendency of seizure with TXA (EACA v TXA: 3.3% v 10%; p>0.05, relative risk 1.53). There was significant increase in the D-dimer from preoperative to postoperative values in Group EACA. (p< 0.01). Conclusions Both EACA and TXA were equally effective in reducing the perioperative blood loss and transfusion requirement in patients undergoing thoracic aortic surgery. While significant renal injury was observed with EACA, there was a tendency for higher incidence of seizure with TXA. Prospective placebo-controlled trials recruiting larger sample size using sensitive biomarkers are required before any recommendations.