Prophylactic epsilon-Aminocaproic Acid (EACA) Administration Minimizes Blood Replacement Therapy During Cardiac Surgery

B leeding after cardiopulmonary bypass is a frequent complication of perioperative patient care. To determine whether prophylactic treatment with e-aminocaproic acid (EACA) minimizes bleeding after cardiopulmonary bypass, a retrospective cohort of patients (n = 350) undergoing coronary artery bypass graft (CABG) or valve replacement surgery were evaluated for intraoperative and postoperative allogeneic blood component therapy. We selected EACA as the drug for prophylaxis in order to provide short-term competitive inhibition of the plasmin-mediated conversion of fibrinogen and fibrin to their respective degradation products. Because existing data show that excessive fibrinolytic activity represents a substantial factor in the hemorrhage tendency that follows cardiopulmonary bypass (l-3), we hypothesized that prebypass EACA administration would be a useful adjunct to existing blood conservation techniques.