Comparison of epsilon aminocaproic acid and low-dose aprotinin in cardiopulmonary bypass: Efficiency, safety and cost

Background. In this study we compared the clinical efficiency, safety, and economic benefit of low-dose aprotinin with epsilon aminocaproic acid (EACA ) in reducing bleeding after cardiopulmonary bypass operation. Methods. In a double-blind, randomized study, 100 patients received low-dos e aprotinin (2 x 10(6) kallikrein inhibitor units) or EACA (20 g). The surg ical procedure was single- or double-valve replacement with or without coro nary artery bypass grafts. Results. Mediastinal chest drainage and transfusion requirements with both therapies were similar. There were no urgent reoperations to secure hemosta sis in either group. Similar levels of D-dimer with both therapies indicate a similar inhibition of fibrinolysis. Release of troponin I was less in th e low-dose aprotinin group 1 and 4 hours after bypass, although electrocard iographic measurements did not reflect this difference. Levels of S-100 bet a and neuron-specific enolase were similar with both therapies, confirming that there was no difference in the occurrence of any adverse neurologic ev ents in either group. Conclusions. Low-dose aprotinin and EACA showed similar effects on the redu ction of intraoperative and postoperative bleeding. The lower cost of EACA with no change in safety outcome suggests it is the preferred treatment. (C ) 2001 by The Society of Thoracic Surgeons.