Chad Knoderer, PharmD
OBJECTIVE: Tranexamic acid (TXA) and ɛ-aminocaproic acid (EACA) are used in coronary bypass surgery for antifibrinolytic therapy. Since the removal of aprotinin, data directly comparing their blood sparing effect and their side effects is still missing.
METHODS: Fifty patients undergoing coronary bypass cardiac surgery at St. Vincent’s Hospital and Health Services in Indianapolis, IN were evaluated in a retrospective cohort study. Perioperative data was collected by a thorough chart review. Patients received EACA from 01/01/2013 to 04/05/2013 or TXA from 05/07/2013 to 12/31/2013. Primary outcome was the amount of chest tube output throughout the hospital stay. Secondary outcomes were the amount of blood transfusion requirements, post-operative complications, number of ICU days, need for re-exploration, and in-hospital mortality.
RESULTS: All demographic and pre-operative parameters were well comparable. There was no difference in chest tube output (EACA 942 ± 371 mL vs. TXA 1162 ± 480 mL, p=0.077). There were also not any differences in blood transfusion requirements (EACA 4.92 ± 3.29 units vs. TXA 3.44 ± 2.10 units, p=0.064), nor in post-operative complications such as atrial fibrillation, unstable blood pressure, pneumonia, or pleural effusions related to surgery (EACA 20% vs. TXA 32%, p=0.520). There were not any patients in the study who experienced a need for re-exploration or in-hospital mortality. The number of days spent in the ICU (EACA 1.60 ± 1.35 vs. TXA 1.08 ± 0.4, p = 0.0717) were also found to be statistically non-significant.
CONCLUSIONS: TXA and EACA are comparable in the effect of chest tube output and blood transfusion requirements, as well as their adverse event profile. Although the number of days spent in the ICU approached statistical significance for favoring TXA, either agent would be appropriate to be utilized at the St. Vincent’s Hospital and Health Services in Indianapolis, IN.
LeCleir, Lisa K.
"Comparison of Tranexamic Acid and Aminocaproic Acid in Coronary Bypass Surgery,"
Butler Journal of Undergraduate Research: Vol. 2
, Article 24.
Available at: http://digitalcommons.butler.edu/bjur/vol2/iss1/24