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The Annals of Thoracic Surgery, Vol 57, 1108-1112, Copyright © 1994 by The Society of Thoracic Surgeons
KV Arom and RW Emery
Desmopressin (DDAVP, 0.3 microgram/kg) has been used routinely after
cardiopulmonary bypass, particularly in patients having antiplatelet
therapy. Recently epsilon-aminocaproic acid (single dose of 5 g) given
before cardiopulmonary bypass has been added to the protocol. One hundred
consecutive patients taking desmopressin and epsilon- aminocaproic acid
(group A) and another 100 taking desmopressin alone (group B) were
analyzed. There was no difference among these two groups in patient age,
sex, preoperative history of bleeding and drug consumption, or number of
patients for elective, urgent, emergent, redo, and reoperation for
bleeding. Results of routine preoperative coagulation studies were within
normal limits in both groups. Preoperative hemoglobin level was 13.5 g/dL
in group A and 13.8 g/dL in group B (p = 0.12). Estimated blood loss in the
operating room was 513 mL for group A and 587 mL for group B (p = 0.07).
The total chest drainage at the end of 24 hours was 492 mL in group A and
746 mL in group B (p = 0.0001). Amicar given before cardiopulmonary bypass
does not lessen operating room blood loss, but significantly decreases
postoperative chest drainage. Group B patients received more fresh frozen
plasma (60 U versus 4 U), more platelets (130 U versus 16 U), and more
cryoprecipitate (118 U versus 10 U) than group A patients. Adding
epsilon-aminocaproic acid could save $206.18 in blood product use per
patient, compared with the expense of $24.12 per patient for E-
aminocaproic acid administration.
ARTICLES
Decreased postoperative drainage with addition of epsilon-aminocaproic acid before cardiopulmonary bypass
Minneapolis Heart Institute, Minnesota.
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