CLINICAL-EVALUATION OF AMINOCAPROIC ACID FOR MANAGING TRAUMATIC HYPHEMA IN CHILDREN

Purpose: The purpose of this study is to determine the incidence of se condary hemorrhage after traumatic hyphema in children and to evaluate the efficacy of epsilon aminocaproic acid in reducing this incidence. Methods: In a prospective, randomized, double-blind study performed b etween November 1987 and February 1994, 94 children admitted for traum atic hyphema were assigned to receive either aminocaproic acid (n = 48 ) (100 mg/kg every 4 hours; maximum, 30 g daily) or placebo (n 46) for 5 days. Patients who had ingested aspirin in the week preceding admis sion were excluded from the study. Results: Mean age of the patients w as 9.4 years. Black patients comprised 4% of the study population. Sec ondary hemorrhage occurred in only three patients (3.2%), two from the placebo group and one from the aminocaproic acid group, none of whom had any complications. The duration of hospital stay and the clot reso rption times were increased significantly in the aminocaproic acid gro up (P < 0.001). Conclusions: The authors report a very low incidence o f secondary hemorrhage compared with most previous studies. This diffe rence is likely related to the small proportion of black patients in o ur study and to the exclusion of patients having ingested aspirin, two factors that seem to be associated with higher rates of rebleeding. T he efficacy of aminocaproic acid could not be determined due to the lo w incidence of hemorrhage. The results of this study, however, suggest that the incidence of secondary hemorrhage in white patients without prior ingestion of aspirin is insufficient to justify routine use of a minocaproic acid in managing traumatic hyphema. Rather, an individuali zed decision based on the risk factors of each patient would seem more appropriate to avoid a slower clot resorption time and possible side effects of this medication.