Specialty
Spotlight

 




 


Anaesthesia


   

 




Bleeding
in Cardiac Surgeries

   

  • Bennett-Guerrero
    E, Sorohan JG, Gurevich ML, et al

    Cost-Benefit
    and Efficacy of Aprotonin Compared with E-Aminocaprioc
    Acid in Patients Having Repeated Cardiac Operations:
    A Randomize Blinded Clinical Trial


    Anesthesiology
    87: 1373-1380, 1997


     

    Bleeding
    is common in cardiac surgeries.
    Fibrinolytic inhibitors like aprotonin are
    routinely administered to improve hemostasis. 
    Because aprotonin costs $ 1080 per patient in
    the USA, the efficacy of e-aminocaproic acid [EACA],
    at $ 11 per patient, in limiting bleeding in
    patients having repeated cardiac surgery, was tested
    in a randomized, multicenter, prospective, blinded
    study.

     

    Either
    aprotonin or EACA was administered to 204 patients.
    Bleeding incidence, thoracic drainage in the first
    24 hours, platelet transfusions, and costs to
    hospital were recorded. Fibrinolytic activity was  measured.
    The influence of changes in estimated
    bleeding-related costs on the relative
    cost-effectiveness of the two therapies was
    evaluated.

     

    Results
    showed aprotonin patients had less thoracic drainage
    and required fewer platelet transfusions than EACA
    patients, and their surgical fields were less
    bloody. Overall
    median bleeding-related costs were a significant
    $725 higher
    per aprotonin patient than EACA patient.
    Mean total bleeding related costs for
    aprotonin were also significantly higher than for
    EACA.

     

    EACA
    was significantly more cost effective than aprotonin
    in the treatment of patients undergoing repeated
    cardiac surgeries.

        

  • Slaughter
    TF, Faghih F, Greenberg CS, et al

    The
    Effects of E-Aminocaproic Acid on Fibrinolysis and
    Thrombin Generation during Cardiac Surgery


    Anesth Analg 85: 1221-1226, 1997


     

    Cardiopulmonary
    bypass [CPB] is associated with hemostatic
    abnormalities mediated, at least in part, by
    fibrinolysis. Antifibrinolytic drugs such
    as synthetic 
    lysine analog, e-aminocaproic acid [EACA] are
    often administered for prophylaxis for cardiac
    surgery patients. Suppression
    of fibrinolytic activity in these patients could
    shift the hemostatic balance toward a
    hypercoagulable prethrombotic state.
    The effect of EACA on bleeding, fibrinolytic
    activity and thrombin generation was examined in
    patients undergoing CPB.

      

    This
    prospective randomized, double-blind trial compared
    EACA with placebo in 39 CPB patients. 
    The patients were randomly assigned to
    receive a preoperative load and continuous infusion
    of EACA or saline throughout surgery, plus an
    additional 3 hours after surgery. 
    Blood samples were collected preoperatively,
    during PCB, 3 hours after CPB and 18 to 20 hours
    after CPB.  Postoperative
    blood loss was assessed 6 and 12 hours after surgery
    by cumulative chest drainage tubes.
    Patients were observed during hospitalization
    for complications. Enzyme-linked
    immunosorbent assays were used to measure
    fibrinolysis activity, thrombin generation and
    soluble fibrin.


     

       


    It
    was observed that in the EACA group, fibrinolytic
    activity was significantly decreased 3 hours after
    surgery compared to the placebo group; this was
    reflected in decreased bleeding.
    There were, however, no detectable
    differences in thrombin or fibrin generation between
    the two groups, thus routine administration of EACA
    may potentiate hypercoagulable prethrombotic
    perioperative states.
    Authors recommend further studies to
    determine whether perioperative administration of
    EACA increase the incidence of thrombotic
    complications.

            




 

 

Specialty Spotlight

 

 
Anaesthesia
   

 

Bleeding in Cardiac Surgeries
   

  • Bennett-Guerrero E, Sorohan JG, Gurevich ML, et al
    Cost-Benefit and Efficacy of Aprotonin Compared with E-Aminocaprioc Acid in Patients Having Repeated Cardiac Operations: A Randomize Blinded Clinical Trial
    Anesthesiology 87: 1373-1380, 1997
     
    Bleeding is common in cardiac surgeries. Fibrinolytic inhibitors like aprotonin are routinely administered to improve hemostasis.  Because aprotonin costs $ 1080 per patient in the USA, the efficacy of e-aminocaproic acid [EACA], at $ 11 per patient, in limiting bleeding in patients having repeated cardiac surgery, was tested in a randomized, multicenter, prospective, blinded study.
     
    Either aprotonin or EACA was administered to 204 patients. Bleeding incidence, thoracic drainage in the first 24 hours, platelet transfusions, and costs to hospital were recorded. Fibrinolytic activity was  measured. The influence of changes in estimated bleeding-related costs on the relative cost-effectiveness of the two therapies was evaluated.
     
    Results showed aprotonin patients had less thoracic drainage and required fewer platelet transfusions than EACA patients, and their surgical fields were less bloody. Overall median bleeding-related costs were a significant $725 higher per aprotonin patient than EACA patient. Mean total bleeding related costs for aprotonin were also significantly higher than for EACA.
     
    EACA was significantly more cost effective than aprotonin in the treatment of patients undergoing repeated cardiac surgeries.
        

  • Slaughter TF, Faghih F, Greenberg CS, et al
    The Effects of E-Aminocaproic Acid on Fibrinolysis and Thrombin Generation during Cardiac Surgery
    Anesth Analg 85: 1221-1226, 1997
     
    Cardiopulmonary bypass [CPB] is associated with hemostatic abnormalities mediated, at least in part, by fibrinolysis. Antifibrinolytic drugs such as synthetic  lysine analog, e-aminocaproic acid [EACA] are often administered for prophylaxis for cardiac surgery patients. Suppression of fibrinolytic activity in these patients could shift the hemostatic balance toward a hypercoagulable prethrombotic state. The effect of EACA on bleeding, fibrinolytic activity and thrombin generation was examined in patients undergoing CPB.
      
    This prospective randomized, double-blind trial compared EACA with placebo in 39 CPB patients.  The patients were randomly assigned to receive a preoperative load and continuous infusion of EACA or saline throughout surgery, plus an additional 3 hours after surgery.  Blood samples were collected preoperatively, during PCB, 3 hours after CPB and 18 to 20 hours after CPB.  Postoperative blood loss was assessed 6 and 12 hours after surgery by cumulative chest drainage tubes. Patients were observed during hospitalization for complications. Enzyme-linked immunosorbent assays were used to measure fibrinolysis activity, thrombin generation and soluble fibrin.

     
       
    It was observed that in the EACA group, fibrinolytic activity was significantly decreased 3 hours after surgery compared to the placebo group; this was reflected in decreased bleeding. There were, however, no detectable differences in thrombin or fibrin generation between the two groups, thus routine administration of EACA may potentiate hypercoagulable prethrombotic perioperative states. Authors recommend further studies to determine whether perioperative administration of EACA increase the incidence of thrombotic complications.
            

 

By |2022-07-20T16:44:10+00:00July 20, 2022|Uncategorized|Comments Off on Cardiac Surgeries

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