Prophylactic tranexamic acid and ε-aminocaproic acid for primary myocardial revascularization

被引:47
作者
Hardy, JF
Bélisle, S
Dupont, C
Harel, F
Robitaille, D
Roy, M
Gagnon, L
机构
[1] Univ Montreal, Montreal Heart Inst, Dept Anesthesia, Montreal, PQ H1T 1C8, Canada
[2] Univ Montreal, Montreal Heart Inst, Dept Biostat, Montreal, PQ H1T 1C8, Canada
[3] Univ Montreal, Montreal Heart Inst, Dept Hematol, Montreal, PQ H1T 1C8, Canada
关键词
D O I
10.1016/S0003-4975(97)01016-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. The efficacy of prophylactic epsilon-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 epsilon-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 epsilon-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 tells was similar in all three groups. Nonetheless, the percentage of patients receiving hemostatic blood products was significantly decreased in the epsilon-aminocaproic acid group compared with the Placebo group (20% versus 43%; p = 0.03). Both tranexamic acid and epsilon-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 epsilon-aminoeaproic acid effectively reduces transfusions in patients undergoing primary, elective myocardial revascularization.
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收藏
页码:371 / 376
页数:6
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