epsilon-aminocaproic acid administration and stroke following coronary artery bypass graft surgery

Background. epsilon-aminocaproic acid is routinely used to reduce bleeding during cardiac surgery. Anecdotal reports of thrombotic complications have led to speculation regarding this drug's safety. We investigated the associ ation between epsilon-aminocaproic acid administration and postoperative st roke. Methods. Six thousand two hundred ninety-eight patients undergoing isolated coronary artery bypass graft surgery between 1989 and 1995 were studied. D ata was obtained from the Duke Cardiovascular Database as well as from an a utomated intraoperative anesthesia record keeper. Patients identified as ha ving postoperative stroke were reviewed and confirmed by a board certified neurologist blinded to epsilon-aminocaproic acid administration. Results. Postoperative stroke occurred in 97 patients (1.5%). Three thousan d one hundred thirty-five (49.8%) patients received epsilon-aminocaproic ac id. Increased age was associated with a higher incidence of postoperative s troke (p = 0.0001). In contrast, there was no significant difference (p = 0 .7370) in the incidence of stroke between use of epsilon-aminocaproic acid (1.3%) and nonuse (1.7%). Multivariable logistic regression found no signif icant effect of epsilon-aminocaproic acid use on stroke after accounting fo r age, date of surgery, and history of diabetes. Conclusions. This series suggests that epsilon-aminocaproic acid administra tion does not increase the risk of postoperative stroke. (Ann Thorac Surg 1 999;67:1283-7) (C) 1999 by The Society of Thoracic Surgeons.