Hemostatic effects of aprotinin, tranexamic acid and ε-aminocaproic acid in primary cardiac surgery

Background. The effects of E-aminocaproic acid (EACA) and tranexamic acid (TA) on bleeding and allogeneic transfusions, and the cost of pharmacological and transfusional treatment were compared to aprotinin (AP). Methods. We randomized 210 patients subjected to elective cardiac surgery. Of these, 68 patients received EACA (a bolus of 5 g, an infusion of 2 g/h, and 2.5 g in the priming), 72 patients received TA (a bolus of 1 g, an infusion of 400 mg/h, and 500 mg in the priming), and 70 patients received AP (a bolus of 280 mg, an infusion of 70 mg/h, and 280 mg in the priming). Postoperative blood loss and homologous transfusions were collected and the cost of pharmacological treatment and homologous transfusions were calculated. Results. Bleeding but not allogeneic transfusions was significantly higher in the EACA group (467 +/- 234 versus TA, 311 +/- 231 versus AP, 283 +/- 233; p < 0.001), Costs of pharmacological and transfusional treatment were significantly lower in the TA group ($58.10 +/- $105.10) versus the EACA group ($100.70 +/- $158.60) versus the AP group ($432.60 +/- $128.70) (p < 0.0001). Conclusions. Compared to AP, TA has the same effects on bleeding and transfusions, but with a significant reduction of costs. Patients treated with EACA showed a significantly higher postoperative bleeding with an increased trend of transfusion requirement. (C) 1999 by The Society of Thoracic Surgeons.