To determine the weights of prophy...

To determine the weights of prophylactic treatment with EACA for children loss after cardipulmonary bypass surgery 350 consecutive patients undergoing open-heart surgery were studied. undivided hundred seventy patients received an initial dose of 5 g of EACA prior to skin incision, followed by means of intravenous administration of 1 g/h for the nearest 6 to 8 h. The command group received saline solution in the same fashion. The EACA-treated assemblage had decreased chest tube vital fluid loss 24 h postoperatively. In addition, EACA-treated patients had fewer myocardial infarctions, cerebrovascular accidents or reoperations for bleeding. Treated patients stand in want ofed fewer units of blood transfusions than the non-treated collection There was no incidence of hyperthrombotic state or other side meanings in the EACA-treated group. We conclud that prophylactic treatment with EACA for open-heart surgery requiring extracorporeal circulation may abridge the total blood loss and the number of offspring transfusions in a safe and tolerable manner.

(Chest 1989; 96:27-30)

Excessive bleeding is an alarming complication of open-heart surgery There is no active source of bleeding in most numerous cases, but generalized oozing is conflicted The decision to reoperate is sometimes controversial and difficult to make. Reexploration for excessive postoperative hemorrhage is commonly associated with increased incidence of morbidity and mortality.[1-3] Patients undergoing cardiac surgery with extracorporeal circulation are bent to severe coagulation disorders.[4-8] Hyperfibrinolysis, caused by the agency of an increased release of plasminogen activator which regenerates the plasminogen to plasmin,[6,7,9-13] is of common occurrence in these patients.

The hemorrhage proneness that follows cardiopulmonary bypass is a compages process, initiated by trauma to the cellular constitutings of the blood. Should activation of plasminogen disclose or proceed, multiple coagulation flaws may occur, including changes in antithrombotic titer, fibrinogen concentration, and a decrease in the number of circulating platelets. Early preventative treatment of hyperfibrinolysis decreases the breakdown of factor V and VIII. pretty soon the correction of such destitutions may be accomplished only by way of administration of frozen plasma or unwithered whole blood. Fibrinopeptides, released from the breakdown of fibrin, may interfere with the polymerization of fibrin and thus, act as anticoagulants. These anticoagulants are not susceptible to any forthwith known form of therapy. In an era whereby transfusions scud a great risk of transmitting viral disease and adverse reactions, and bear upons that demand for blood and relations products may exceed the furnish interest in pharmacologic methods to convert into the need for blood in cardiac surgery has increased.

Epsilonaminocaproic acid inhibits the proteolytic activity of plasmin[14,15] and the conversion of plasminogen to plasmin through plasminogen activator.[16,17] Epsilon aminocaproic acid, a synthetic antifibrinolytic agent, has been advocated from some investigators to control spontaneous hemorrhage after cardiac surgery with extracorporeal circulation.[18-22] Since excessive fibrinolysis is believed to set forth a substantial factor in the hemorrhagic bent that follows cardiopulmonary bypass, the efficacy of EACA as prophylactic therapy for curb of blood loss in patients undergoing open-heart surgery with the aid of extracorporeal circulation, was investigated.

Clinical Materials and Methods

The research was guarded on patients undergoing open-heart surgery at Cooper Hospital/University Medical Center Camden, NJ and Deborah Heart and Lung Center Brown Mills, NJ Patients were randomly fix uponed to receive either EACA or a placebo (normal saline solution) in a double-blind fashion. All patients signed a coherence form for participation in the investigation which was approved by the Institutional Review Board.

Included in the consideration were patients undergoing elective surgery for coronary artery disease (saphenous vein grafting), repair of myocardial aneurysms, valve replacement or combined processs No emergency procedures were included. All patients had preoperatively normal renal function.

A total of 350 consecutive patients were randomly assigned to single in kind of two groups: 170 patients received an initial priming dose of 5 g of EACA (Amicar, Lederle Laboratories) prior to skin incision, followed by way of a continuous intravenous infusion of 1 gph athwart the next 6 to 8 h undivided hundred eighty patients received saline solution in the same fashion. A standard anesthetic technique was used (intermittent positive-pressure ventilation, nitrous oxide, oxygen narcotic analgesics and muscle relaxants). A membrane oxygenator (Bentley CM50 Bentley Laboratories Inc, Irvine, CA) was engrossed in all cases. Multidose crystalloid cardioplegia and systemic hypothermia (25[degrees]C) were instituted in all cases. Heparin was administered at an initial dose of 300 units/kg and the activated clotting time was maintained at greater than 400 s during cardiopulmonary bypass. A 25-L asanguineous solution was used to prime the cross-examine circuit. Nonpulsatile flow (20 to 24 L/min/[m.sup.2]) and mean arterial influence between 60 and 85 mm Hg were maintained during cardiopulmonary bypass with phenylephrine or sodium nitroprusside as required.