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Manfred Dahm
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Ann Thorac Surg 1998;65:667-673
© 1998 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

High-Dose {epsilon}-Aminocaproic Acid Versus Aprotinin: Antifibrinolytic Efficacy in First-Time Coronary Operations

Balthasar Eberle, MD, Eckhard Mayer, MD, Gerhard Hafner, MD, Jens Heinermann, Manfred Dahm, MD, PhD, Winfried Prellwitz, MD, Wolfgang Dick, MD, Hellmut Oelert, MD, PhD

Department of Anaesthesiology, Johannes Gutenberg University, Mainz, Germany
Department of Cardiothoracic & Vascular Surgery, Johannes Gutenberg University, Mainz, Germany
Institute for Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg University, Mainz, Germany

Accepted for publication September 3, 1997.

Dr Eberle, Department of Anesthesiology, Johannes Gutenberg University Medical School, Langenbeckstr 1, D-55131 Mainz, Germany (e-mail: beberle@anaesthesie.klinik.uni-mainz.de).

Background. The antifibrinolytic efficacy of a high-dose regimen of {epsilon}-aminocaproic acid ({epsilon}-ACA) was compared with aprotinin in first-time coronary operations.

Methods. In a prospective, double-blinded, randomized study, 20 patients received high-dose {epsilon}-ACA (10 g both as a loading and cardiopulmonary bypass priming dose, 2.5 g/h until 4 hours after protamine), and another 20 patients received aprotinin (2 x 106 KIU [280 mg] for loading and priming, 0.5 x 106 KIU/h [70 mg/h]). Ten untreated patients served as controls.

Results. Both agents reduced postoperative levels of thrombin/antithrombin III complexes, D-dimers, fibrin degradation products, free plasma hemoglobin ({epsilon}-ACA versus aprotinin, p = not significant; p < 0.05 versus controls), and amount of retransfused autologous blood (p < 0.001). {epsilon}-ACA increased, aprotinin suppressed antiplasmin–plasmin complex generation ({epsilon}-ACA versus controls, p < 0.02; {epsilon}-ACA versus AP, p < 0.0001). For 4 hours after discontinuation, more chest drainage occurred with {epsilon}-ACA than aprotinin (137 ± 90 mL versus 62 ± 29 mL; means ± standard deviation; p < 0.02). Cumulative 12-hour drainage was similar for aprotinin (391 ± 220 mL) and {epsilon}-ACA (582 ± 274 mL), but higher without inhibitor (1,091 ± 541 mL; p < 0.001 versus drugs). Postoperatively, aprotinin was associated with the lowest autologous retransfusion incidence and highest hematocrits (p < 0.01 versus {epsilon}-ACA). Homologous transfusion exposures did not differ.

Conclusions. In first-time coronary operations, higher postoperative hematocrit and less shed blood retransfusion constitute only subtle advantages of aprotinin over high-dose {epsilon}-ACA.




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