Tranexamic acid reduces red cell transfusion better than epsilon-aminocaproic acid or placebo in liver transplantation

We evaluated the efficacy of the prophylactic administration of epsilon-ami nocaproic acid and tranexamic acid for reducing blood product requirements in orthotopic liver transplantation (OLT) in a prospective, double-blinded study performed in 132 consecutive patients. Patients were randomized to th ree groups and given one of three drugs prophylactically: tranexamic acid, 10 mg . kg(-1) . h(-1); epsilon-aminocaproic acid, 16 mg . kg(-1) . h(-1), and placebo (isotonic saline). Perioperative management was standardized. C oagulation tests, thromboelastogram, and blood requirements were recorded d uring OLT and in the first 24 h. There were no differences in diagnosis, Ch ild score, or preoperative coagulation tests among groups. Administration o f packed red blood cells was significantly reduced (P = 0.023) during OLT i n the tranexamic acid group, but not in the epsilon-aminocaproic acid group . There were no differences in transfusion requirements after OLT. Thromboe mbolic events, reoperations, and mortality were similar in the three groups . Prophylactic administration of tranexamic acid, but not epsilon-aminocapr oic acid, significantly reduces total packed red blood cell usage during OL T.