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J Thorac Cardiovasc Surg 1996;112:1098-1107
© 1996 Mosby, Inc.
CARDIOPULMONARY BYPASS, |
Received for publication Jan. 22, 1996 Revisions requested March 13, 1996; revisions received April 23, 1996 Accepted for publication June 4, 1996. Address for reprints: Thomas J. Vander Salm, MD, Department of Surgery, University of Massachusetts Medical School, 55 Lake Avenue, N. Worcester, MA 01655-0333.
Abstract
Excessive postoperative bleeding after heart operations continues to be a source of morbidity. This prospective double-blind study evaluated epsilon-aminocaproic acid as an agent to reduce postoperative bleeding and investigated its mode of action. One hundred three patients were randomly assigned to receive either 30 gm epsilon-aminocaproic acid (51 patients) or an equivalent volume of placebo (52 patients). In a subset of these patients (14 epsilon-aminocaproic acid, 12 placebo), tests of platelet function and fibrinolysis were performed.Results: By multivariate analysis, three factors were associated with decreased blood loss in the first 24 hours after operation: epsilon-aminocaproic acid versus placebo (647 ml versus 839 ml, p = 0.004), surgeon 1 versus all other surgeons (582 ml versus 978 ml,p = 0.002), and no intraaortic balloon versus intraaortic balloon pump use (664 ml versus 1410 ml,p = 0.02). No significant differences in platelet function could be demonstrated between the two groups. Inhibited fibrinolysis, as reflected by less depression of the euglobulin clot lysis and no rise in d-dimer levels, was significant in the epsilon-aminocaproic acid group compared with the placebo group.Conclusion: The intraoperative use of epsilon-aminocaproic acid reduces postoperative cardiac surgical bleeding. (J THORAC CARDIOVASC SURG 1996;112:1098-107)
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