Hemostatic effects of aprotinin, tranexamic acid and epsilon-aminocaproic acid in primary cardiac surgery

Background. The effects of E-aminocaproic acid (EACA) and tranexamic acid ( TA) on bleeding and allogeneic transfusions, and the cost of pharmacologica l and transfusional treatment were compared to aprotinin (AP). Methods. We randomized 210 patients subjected to elective cardiac surgery. Of these, 68 patients received EACA (a bolus of 5 g, an infusion of 2 g/h, and 2.5 g in the priming), 72 patients received TA (a bolus of 1 g, an infu sion of 400 mg/h, and 500 mg in the priming), and 70 patients received AP ( a bolus of 280 mg, an infusion of 70 mg/h, and 280 mg in the priming). Post operative blood loss and homologous transfusions were collected and the cos t of pharmacological treatment and homologous transfusions were calculated. Results. Bleeding but not allogeneic transfusions was significantly higher in the EACA group (467 +/- 234 versus TA, 311 +/- 231 versus AP, 283 +/- 23 3; p < 0.001), Costs of pharmacological and transfusional treatment were si gnificantly lower in the TA group ($58.10 +/- $105.10) versus the EACA grou p ($100.70 +/- $158.60) versus the AP group ($432.60 +/- $128.70) (p < 0.00 01). Conclusions. Compared to AP, TA has the same effects on bleeding and transf usions, but with a significant reduction of costs. Patients treated with EA CA showed a significantly higher postoperative bleeding with an increased t rend of transfusion requirement. (C) 1999 by The Society of Thoracic Surgeo ns.