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Cary J. Lambert
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Gerald F. Geisler
Maurice Adam
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Ann Thorac Surg 1979;28:440-444
© 1979 The Society of Thoracic Surgeons

Articles

The Treatment of Postperfusion Bleeding Using {epsilon}-Aminocaproic Acid, Cryoprecipitate, Fresh-Frozen Plasma, and Protamine Sulfate

Cary J. Lambert, M.D., Alain J. Marengo-Rowe, M.D.*, James E. Leveson, Ph.D., Robert H. Green, M.D., J. Peter Thiele, M.D., Gerald F. Geisler, M.D., Maurice Adam, M.D., Ben F. Mitchel, M.D.

From the Departments of Thoracic Surgery and Special Hematology, Baylor University Medical Center and Wadley Central Blood Bank, Dallas, TX.

* Address reprint requests to Dr. Marengo-Rowe, Special Hematology Department, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246.

The evaluation of excessive hemorrhage was carried out in 774 patients after cardiopulmonary bypass. Excessive hemorrhage was defined in any adult patient as chest tube drainage of more than 600 ml within the first eight hours after operation. Using the prothrombin time, partial thromboplastin time, fibrinogen level, and tri-F titer tests, it was possible to differentiate medical from surgical bleeding. Hyperfibrinolytic bleeding was the most frequently identifiable coagulation disorder and occurred in 159 patients (20%). All these patients were successfully treated with Amicar ({epsilon}-aminocaproic acid) alone, or with Amicar supplemented with cryoprecipitate or fresh-frozen plasma. Three patients (0.4%) were noted to have residual heparin and required additional protamine sulfate. Five patients (0.6%) had normal coagulation studies and required immediate reexploration. The overall blood consumption per patient was 2.1 units of packed cells. Whole blood and platelets were not used.




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