Efficacy of epsilon-aminocaproic acid in children undergoing cardiac surgery

Objective: To compare coagulation test results, blood loss, and blood produ ct transfusions between patients receiving prophylactic epsilon-aminocaproi c acid (EACA) and a control group matched for age, resternotomy, and surger y in children undergoing cardiac surgery. Design: Nested case-control study. Setting: University-affiliated. pediatric medical center. Participants: Same study period; 70 patients in EACA group and 70 patients in control group. Interventions: Prophylactic EACA administered intravenously (load, 150 mg/k g, infusion; 30 mg/kg/h) to 70 patients at increased risk for bleeding (reo peration or Ross procedure). Measurements and Main Results: Coagulation test values were measured before , during, and after cardiopulmonary bypass (CPB). Intraoperative blood loss , postoperative chest tube output, and allogenic blood product transfusions were recorded. Comparison of demographic and surgical data indicated close matching of the EACA and control groups. The EACA group ([median, 25th to 75th quartile] 15.6 mL/kg; 9.2 to 26.3 mL/kg) had less intraoperative blood loss than the control group (22.2 mL/kg; 14.3 to 36.3 mL/kg; p = 0.02). Po stoperative chest tube output at 6 hours (p = 0.08), 12 hours (p = 0.07), a nd 24 hours (p = 0.08) was not significantly different between groups. Fewe r EACA group patients required reexploration for bleeding (p < 0.05). There was no difference between groups in blood products transfused (in millilit ers per kilogram or allogenic exposure per patient). Thromboelastography va lues (maximum amplitude [MA], whole blood clot lysis index at 30 minutes af ter MA) during CPB were better preserved in the EACA group. Conclusion: EACA reduced intraoperative blood loss but did not significantl y decrease blood product transfusions. Lack of efficacy may be related to r elative underdosing and should be further studied. Copyright (C) 1999 by W. B. Saunders Company.