Original Research

Blood Conservation Using Tranexamic Acid versus Epsilon Aminocaproic Acid in Cardiac Surgery: A Randomized Controlled Trial

Jason Gatling , Davinder Ramsingh , Justin Horricks , Ryan Lauer , Stanley Brauer , Johnthan Debooy , Carin Mascetti , Richard Applegate
J Anesth Perioper Med 2018; 5(4): 169- 175 . Published on Jul 28, 2018 . doi:10.24015/JAPM.2018.0071
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Abstract

Background: This study compares the efficacy of tranexamic acid (TXA) to epsilon aminocaproic acid (EACA) in reducing blood loss in patients undergoing cardiac surgery.
 
Methods: This was a double-blinded randomized trial.  Patients (n = 100) undergoing cardiac surgery were randomized to receive either TXA (10 mg/kg bolus followed by an infusion of 1 mg/kg/hr) or EACA (150 mg/kg bolus followed by an infusion of 20 mg/kg/hr). The primary outcome measure was a difference in transfusion amounts. Secondary outcomes measured included: the amount of transfusion during the operative procedure, calculated Red blood cell (RBC) volume change, postoperative creatinine, time to extubation, chest tube output and length of ICU stay. 
 
Results: A total of 100 patients consented, of whom 82 completed participation in the study (EACA arm = 42 patients and TXA arm = 40 patients). There was no difference in patient demographics. Similarly, there was no difference between the type of cardiac surgery, cardiopulmonary bypass (CPB) time, intraoperative fluids, and procedure time. Primary marker comparison showed no difference in the frequency or amount of transfusion between groups in the operating room, ICU, or in total.  Additionally, there was no difference in hematocrit (Hct), chest tube output, time to extubation, and length of stay. Post Hoc analysis indicated that red blood cell volume change through postoperative day 2 was larger in TXA than EACA; P = 0.03).  
 
Conclusion: There was no difference in clinically significant outcome criteria between the TXA and EACA groups. Given the lower cost of EACA, this study further supports EACA as an appropriate antifibrinolytic agent for cardiac surgery. (Funded by the Department of Anesthesiology, Loma Linda University Medical Center; ClinicalTrials.gov number, NCT01248104.) 
 
 
 
 
Citation: Jason Gatling, Davinder Ramsingh, Justin Horricks, Ryan Lauer, Stanley Brauer, Johnthan Debooy, Carin Mascetti, Richard Applegate. Blood Conservation Using Tranexamic Acid versus Epsilon Aminocaproic Acid in Cardiac Surgery: A Randomized Controlled Trial. J Anesth Perioper Med 2018; 5 : 169-175. doi: 10.24015/JAPM.2018.0071
 
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