Can epsilon-aminocaproic acid balance the off-pump bleeding advantage?

Area of Science:

• Cardiovascular Surgery
• Pharmacology
• Hemostasis

Background:

• Aprotinin use for surgical bleeding was halted due to bovine spongiform encephalopathy risks.
• Epsilon-aminocaproic acid emerged as a satisfactory alternative for bleeding control.
• The study aimed to precisely assess epsilon-aminocaproic acid's effectiveness in managing postoperative bleeding.

Purpose of the Study:

• To compare postoperative bleeding in on-pump versus off-pump myocardial revascularization patients treated with epsilon-aminocaproic acid.
• To evaluate the efficacy of epsilon-aminocaproic acid in controlling bleeding during cardiopulmonary bypass surgery.

Main Methods:

• Retrospective review of two homogeneous groups of patients undergoing double aortocoronary bypass surgery.
• On-pump group: received cardiopulmonary bypass and epsilon-aminocaproic acid (left anterior descending and circumflex arteries).
• Off-pump group: did not receive cardiopulmonary bypass (left anterior descending and right coronary arteries).

Main Results:

• At 4 hours post-surgery, on-pump patients had significantly more bleeding (328.4±131.4 mL) than off-pump patients (265±91.7 mL) (p=0.004).
• At 24 hours, bleeding differences persisted, with on-pump patients showing higher volumes (827.8±514.4 mL) compared to off-pump (671.6±311.5 mL), though not statistically significant (p=0.07).

Conclusions:

• Epsilon-aminocaproic acid demonstrates effectiveness in managing postoperative bleeding in myocardial revascularization patients.
• The antifibrinolytic agent aids in controlling bleeding, even in complex on-pump procedures.
• Results support the continued use of epsilon-aminocaproic acid in cardiac surgery for bleeding management.