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Traumatic hyphema in children. Treatment with epsilon-aminocaproic acid
S P Kraft1, M D Christianson, J S Crawford
1Department of Ophthalmology, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Epsilon-aminocaproic acid (EACA) did not reduce rebleeds in traumatic hyphema patients and prolonged hyphema clearance. Further research is needed to determine EACA
Area of Science:
- Ophthalmology
- Trauma Care
- Pharmacology
Background:
- Traumatic hyphema is a common eye injury in children and adolescents.
- Rebleeding is a significant complication of traumatic hyphema, potentially leading to vision loss.
- Antifibrinolytic agents like epsilon-aminocaproic acid (EACA) are explored for managing hyphema complications.
Purpose of the Study:
- To evaluate the efficacy of epsilon-aminocaproic acid (EACA) in reducing rebleeding rates in pediatric patients with traumatic hyphema.
- To assess the impact of EACA on the resolution time of hyphemas.
Main Methods:
- A randomized, placebo-controlled trial involving 49 patients (ages 3-18) with nonpenetrating unilateral traumatic hyphema.
- Patients received either oral EACA (100 mg/kg every 4 hours for 5 days) or a placebo.
- Exclusion of patients using acetylsalicylic acid (ASA)-containing compounds prior to or during admission.
Main Results:
- Two of 24 patients treated with EACA experienced rebleeds, compared to 1 of 25 in the placebo group.
- Hyphema clearance was significantly prolonged in the EACA group (mean 5.3 days) versus the placebo group (mean 2.6 days; P < 0.001).
- The low rebleed rate in the placebo group precluded a definitive determination of EACA's efficacy in preventing rebleeds.
Conclusions:
- Epsilon-aminocaproic acid (EACA) did not demonstrate efficacy in reducing rebleeding rates for traumatic hyphema in this study.
- EACA significantly delayed the resolution of hyphemas, suggesting a potential negative impact on recovery.
- Further studies controlling for confounding factors are necessary before considering EACA for traumatic hyphema management.
Abstract:
Forty-nine patients, ages 3 to 18 years, who sustained nonpenetrating unilateral trauma with hyphemas were assigned randomly to receive either 100 mg/kg of epsilon-aminocaproic acid (EACA), an antifibrinolytic agent, orally every 4 hours for 5 days (maximum 30 g/day) or a placebo. No patients ingested acetylsalicylic acid (ASA)-containing compounds before or during admission. Two patients of 24 treated with EACA and 1 of 25 given placebo had rebleeds. The hyphemas in the EACA-treated group took significantly longer to clear (mean, 5.3 versus 2.6 days; P less than 0.001). Because of the low incidence of rebleeds in the placebo group, the efficacy of EACA in reducing the rate of rebleeds could not be determined. Further studies with this drug, controlling for age, race, sickle trait, and pre-admission antiplatelet agents should be undertaken before its routine use in traumatic hyphema management can be recommended.