Prophylactic Tranexamic Acid and ϵ-Aminocaproic Acid for Primary Myocardial Revascularization

Background. The efficacy of prophylactic ϵ-aminocaproic acid and tranexamic acid to reduce transfusions after primary myocardial revascularization was evaluated in a teaching hospital context. Methods. Patients (n = 134) received either ϵ-aminocaproic acid (15-g bolus + infusion of 1 g/h), high-dose tranexamic acid (10-g bolus + placebo infusion), or normal saline solution in a double-blind fashion. Anticoagulation and conduct of cardiopulmonary bypass were standardized. Results. Tranexamic acid and ϵ-aminocaproic acid produced a significant reduction in postoperative blood loss compared with placebo (median loss, 438 mL, 538 mL, and 700 mL, respectively). Transfusion of red cells was similar in all three groups. Nonetheless, the percentage of patients receiving hemostatic blood products was significantly decreased in the ϵ-aminocaproic acid group compared with the placebo group (20% versus 43%; p = 0.03). Both tranexamic acid and ϵ-aminocaproic acid significantly decreased total exposure to allogeneic blood products compared with placebo ( p = 0.01 and p = 0.05, respectively), and this reduction was clinically important (median exposure, 2, 2, and 7.5 units, respectively). Fibrinolysis was inhibited significantly in both treatment groups. Conclusions. We conclude that either high-dose tranexamic acid or ϵ-aminocaproic acid effectively reduces transfusions in patients undergoing primary, elective myocardial revascularization.