ε-Aminocaproic acid does not increase adverse effects in cardiac surgery: an analysis of 2,852 cases

Abstract

Introduction Antifibrinolytic drugs recently have been associated with adverse outcomes in patients undergoing cardiac surgery. We reviewed our experience with prophylatic epsilon-aminocaproic acid in patients undergoing cardiac surgery at InCor - Heart Institute. Methods We retrieved data on 2,852 consecutive patients undergoing cardiac surgery at revascularization at Duke between 1 January 2004 and 31 December 2008. We compared patients receiving or not prophylatic epsilon-aminocaproic acid in coronary artery bypass graft surgery, or valve procedures or combined ones. We evaluated baseline characteristics, intraoperative data and severe clinical endpoints during 30 days. Results A total of 2,852 patients were included in the analysis and 1,389 (48.7%) received prophylactic epsilon-aminocaproic acid. The others did not receive any antifibrinolytic. In the risk-adjusted model, survival was similar among patients treated with aminocaproic acid or not treated (1.9 vs. 1.6%, P = 0.48). Bleeding in 24 hours was reduced in the treated group as compared with the nontreated (391 vs. 472 ml, P = 0.012). There were no differences regarding acute renal failure, stroke and infection in 30 days. Conclusion In cardiac surgery, prophylactic use of aminocaproic acid reduces bleeding and does not result in higher incidence of acute complications.