TRANEXAMIC ACID REDUCES BLEEDING AFTER CARDIOPULMONARY BYPASS WHEN COMPARED TO EPSILON-AMINOCAPROIC ACID AND PLACEBO

Perioperative bleeding following coronary artery bypass grafting (CABG ) is associated with increased blood product usage. Although aprotonin is effective in reducing perioperative blood loss, excessive cost pro hibits routine utilization. Epsilon aminocaproic acid (EACA) and trane xamic acid (TA) are inexpensive antifibrinolytic agents, which, when g iven prophylactically, may reduce blood loss. The present study was un dertaken to compare the efficacy of TA and EACA in reducing perioperat ive blood loss. Methods: The study population consisted of first-time CABG patients. Patients were allocated in a prospective double-blind f ashion: (1) group EACA (loading dose 150 mg/kg, continuous infusion 10 mg/kg per hour for 6 hours, N = 20); (2) group TA (loading dose 15 mg /kg, continuous infusion 1 mg/kg per hour for 6 hours, N = 20); (3) co ntrol group (infusion of normal saline for 6 hours, N = 19). Results: Treatment groups were similar preoperatively. No significant differenc e in intraoperative blood loss or perioperative use of blood products was noted. D-dimer concentration was elevated in the control group com pared to the EACA and TA groups (p < 0.05). Group TA had less postoper ative blood loss than the EACA and control groups at 6 and 12 hours po stoperatively (p < 0.05). TA had reduced total blood loss (600 +/- 49 mL) postoperatively compared to EACA (961 +/- 148 mL) and control (106 0 +/- 127 mL, p < 0.05). Conclusion: TA and EACA effectively inhibited fibrinolytic activity intraoperatively and throughout the first 24 ho urs postoperatively. TA was more effective in reducing blood loss post operatively following CABG. This suggests that TA may be beneficial as an effective and inexpensive antifibrinolytic in first-time CABG pati ents.