EFFECT OF PROPHYLACTIC EPSILON-AMINOCAPROIC ACID ON BLOOD-LOSS AND TRANSFUSION REQUIREMENTS IN PATIENTS UNDERGOING FIRST-TIME CORONARY-ARTERY BYPASS-GRAFTING - A RANDOMIZED, PROSPECTIVE, DOUBLE-BLIND-STUDY

The prophylactic use of aprotinin has recently been reported to be ass ociated with a significant decrease in blood loss in patients undergoi ng cardiopulmonary bypass: procedures. One of the primary effects of a protinin is prevention of plasmin degradation of platelet function. Be cause aprotinin is commercially unavailable in the United States at th is time, we evaluated epsilon-aminocaproic acid with respect to decrea sed perioperative blood loss. We prospectively randomized 40 patients undergoing first-time coronary artery bypass grafting without prior st ernotomy into two groups: one group (n = 21) received prophylactic and preincision epsilon-aminocaproic acid and the other (n = 19) received a placebo. No significant differences existed between patient groups with respect to age, body surface area, cardiopulmonary bypass time, a nd aortic crossclamp time. Cumulative blood loss at 4, 8, 12, and 24 h ours after chest closure was significantly less in the epsilon-aminoca proic acid group (426 +/- 242 ml versus 634 +/- 224 ml, p = 0.002, at 12 hours). Only one patient receiving epsilon-aminocaproic acid was gi ven blood or blood components compared to five patients in the placebo group (p < 0.02). D-dimers and fibrin split products were significant ly less prevalent in the epsilon-aminocaproic acid group (at 4 hours: 0/20 versus 7/16, p < 0.002 and 5/20 versus 12/19, p < 0.05, respectiv ely). None of the patients had a perioperative myocardial infarction o r cerebrovascular accident. The prophylactic administration of epsilon -aminocaproic acid results in a significant decrease in blood loss in patients undergoing first-time coronary artery bypass grafting, and bl ood transfusion requirements are significantly less. It may be importa nt to administer epsilon-aminocaproic acid before skin incision to be optimally effective.