Efficacy of aprotinin, epsilon aminocaproic acid, or combination in cyanotic heart disease

Background. Aprotinin and epsilon aminocaproic acid are antifibrinolytic ag ents used to reduce postoperative blood loss after cardiopulmonary bypass. We compared low dose aprotinin with epsilon aminocaproic acid and a combina tion of the two agents to reduce postoperative blood loss in infants with c ongenital cyanotic heart disease undergoing corrective surgical procedures. Methods. This prospective study was conducted randomly on 300 children. Gro up I (n = 80) acted as the control and did not receive either of the study drugs. Group II (n = 100) received low dose aprotinin, group III (n = 60) r eceived epsilon aminocaproic acid, and group IV (n = 60) received a combina tion of the two antifibrinolytic agents. Results. The control group had the longest time for sternal closure, maximu m blood loss at 24 hours, and greatest requirements for packed red blood ce lls and platelets. Fibrinogen levels were significantly lower, and levels o f fibrin breakdown products were significantly higher compared with the gro ups given either or both of the antifibrinolytics. Conclusions. Epsilon aminocaproic acid is as efficacious as low dose aproti nin in reducing postoperative blood loss and packed red blood cell and plat elet requirements in children with congenital cyanotic heart disease. The c ombination of the two was slightly more effective. (C) 2000 by The Society of Thoracic Surgeons.