Comparison of effectiveness and safety of epsilon-aminocaproic acid and tranexamic acid in adult patients undergoing cardiac surgery
Langpoklakpam Chaoba Singh1, Sanjeev Singh2, Isaac Okyere3, Anbarasu Annamalai4, Arti Singh5
1 Department of Anaesthesia, RIMS, Imphal, Manipur, India
2 Departments of Anaesthesiology and Intensive Care, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Cardiac Anaesthesia, SAMSRI, Lucknow, Uttar Pradesh, India
3 Departmentof Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
4 Department of Cardiac Anaesthesia, SAMSRI, Lucknow, Uttar Pradesh, India
5 Department of Community Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Department of Anaesthesiology and Intensive Care, Kwame Nkrumah University of Science and Technology, Kumasi
Source of Support: None, Conflict of Interest: None
Objective: The objective of the study is to evaluate the effectiveness and safety of epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA) in reducing bleeding, re-exploration, and blood transfusion in patients who underwent a cardiac surgical procedure for mitral valve replacement on cardiopulmonary bypass.
Methods: A single-center, prospective, randomized, and double-blind clinical comparison study was conducted after obtaining institutional ethical approval; sixty patients of either gender between 18 and 60 years of age were randomly divided into two batches: EACA batch (n = 30) given 100 mg/kg EACA as a bolus during induction of anesthesia and then infused at 20 mg/kg/h during surgery and 6 h after surgery and TXA batch (n = 30) given TXA 20 mg/kg/h as a bolus during induction of anesthesia and then infused at 2 mg/kg/h during surgery and 6 h after surgery. The patient parameters, blood loss, transfusion requirements in the first 24 h, and other complications were recorded.
Results: Blood loss per hour through the chest tube drain was significantly lower for the first 6 postoperative hours in the TXA than in the EACA (P < 0.05). The total postoperative blood loss was 416 ± 47.74 ml and 489 ± 42.12 ml in 24 h (P = 0.0001), and the blood transfusion requirement was 0.45 ± 0.62 units and 0.86 ± 0.87 units (P = 0.0481) in the TXA and EACA, respectively. The re-exploration rate was 3.34% and 13.34% in TXA and EACA (P = 0.0629). Five percent of the patients reported seizures in the study (P > 0.05). The findings of this study suggested that prophylactic therapy with EACA or TXA was effective and safer in reducing perioperative blood loss in cardiac surgical procedures with mitral valve replacement. Furthermore, TXA was significantly more effective than EACA.