scholarly journals The Effect of Low Doses of Epsilon-Aminocaproic Acid on Blood Loss Following Cardiac Surgery under Cardiopulmonary Bypass

2019 ◽  
pp. 70-76
Author(s):  
D. V. Osipenko ◽  
A. A. Skorokhodov ◽  
A. A. Silanov
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Loss ◽  
Randomized Study ◽  
Aminocaproic Acid ◽  
Control Group ◽  
Low Doses ◽  
Thoracic Drainage ◽  
Group 2 ◽  
Epsilon Aminocaproic Acid

Objective: to study the effectiveness of the application of low doses of epsilon-aminocaproic acid (EACA) (8-12 g) during cardiac operations under cardiopulmonary bypass (CPB) with the assessment of the effect on blood loss, number of transfusions, complications, and thromboelastometry parameters. Material and methods. The prospective, randomized study included 113 patients undergoing routine cardiac surgery under cardiopulmonary bypass. Two groups were formed: group 1 (n = 51) - an EACA bolus of 75 mg/kg was administered intravenously with titration of 30 mg/kg/h during CPB; group 2 (n = 62) was the control group. Conclusion. The introduction of low doses of EACA (10.2 (8.9; 11.4) g) reduces the thoracic-drainage volume by 30 %, reduces the frequency of donor blood transfusions by 38 % within 36-48 hours after the surgery without increasing the number of complications.

Dosage of Epsilon-Aminocaproic Acid to Reduce Postoperative Blood Loss

2000 ◽  
Vol 8 (1) ◽  
pp. 15-18 ◽  
Author(s):  
Sandeep Chauhan ◽  
Akshay Kumar Bisoi ◽  
Beeraka Heramba Rao ◽  
M Sanjeeva Rao ◽  
Nita Saxena ◽  
...  
Keyword(s):  
Blood Loss ◽  
Artery Bypass ◽  
Aminocaproic Acid ◽  
Postoperative Blood Loss ◽  
Control Group ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Epsilon Aminocaproic Acid ◽  
First Time

Postoperative blood loss, blood and blood-product requirements, and complications were compared for 3 commonly used doses of epsilon-aminocaproic acid in 150 patients undergoing first-time coronary artery bypass surgery. The patients were randomly assigned to one of 4 groups. Group 1 (n = 30) served as a control, group 2 (n = 30) received a single dose of 150 mg·kg−1 of epsilon-aminocaproic acid after anesthetic induction, group 3 (n = 30) received a loading dose of 150 mg·kg−1 followed by infusion of 1 g·h−1 for 6 hours, and group 4 (n = 60) received doses of 150 mg·kg−1 at induction, on bypass, and after protamine. No patients, including those who had endarterectomies, experienced any complications attributable to epsilon-aminocaproic acid administration. All patients who received epsilon-aminocaproic acid had significantly less bleeding compared to controls. Groups 3 and 4 had the least blood loss and packed-cell requirements.

scholarly journals Comparative evaluation of blood salvage techniques in patients undergoing cardiac surgery with cardiopulmonary bypass

Perfusion ◽  
2017 ◽  
Vol 33 (2) ◽  
pp. 105-109 ◽  
Author(s):  
Serdar Gunaydin ◽  
Craig Robertson ◽  
Ali Baran Budak ◽  
Terence Gourlay
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Cells ◽  
Randomized Study ◽  
White Blood Cells ◽  
Cell Saver ◽  
Blood Salvage ◽  
Group 2 ◽  
Intraoperative Blood Salvage ◽  
Group 1

Background: The primary objective of this study was to test and compare the efficacy of currently available intraoperative blood salvage systems via a demonstration of the level of increase in percentage concentration of red blood cells (RBC), white blood cells 9WBC) and platelets (Plt) in the end product. Methods: In a prospective, randomized study, data of 80 patients undergoing elective cardiac surgery with cardiopulmonary bypass in a 6-month period was collected, of which the volume aspirated from the surgical field was processed by either the HemoSep Novel Collection Bag (Advancis Surgical, Kirkby-in-Ashfield, Notts, UK) (N=40) (Group 1) or a cell- saver (C.A.T.S Plus Autotransfusion System, Fresenius Kabi, Bad Homburg, Germany) (N=40) (Group 2). Results: Hematocrit levels increased from 23.05%±2.7 to 43.02%±12 in Group 1 and from 24.5±2 up to 55.2±9 in Group 2 (p=0.013). The mean number of platelets rose to 225200±47000 from 116400 ±40000 in the HemoSep and decreased from 125200±25000 to 96500±30000 in the cell-saver group (p=0.00001). The leukocyte count was concentrated significantly better in Group 1 (from 10100±4300 to 18120±7000; p=0.001). IL-6 levels (pg/dL) decreased from 223±47 to 83±21 in Group 1 and from 219±40 to 200±40 in Group 2 (p=0.001). Fibrinogen was protected significantly better in the HemoSep group (from 185±35 to 455±45; p=0.004). Conclusions: Intraoperative blood salvage systems functioned properly and the resultant blood product was superior in terms of red blood cell species. The HemoSep group had significantly better platelet and leukocyte concentrations and fibrinogen content.

Efficacy of a Simple Intraoperative Transfusion Algorithm for Nonerythrocyte Component Utilization after Cardiopulmonary Bypass

2001 ◽  
Vol 94 (5) ◽  
pp. 773-781 ◽  
Author(s):  
Gregory A. Nuttall ◽  
William C. Oliver ◽  
Paula J. Santrach ◽  
Sandra Bryant ◽  
Joseph A. Dearani ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Loss ◽  
Operating Room ◽  
Prospective Trial ◽  
Median Number ◽  
Control Group ◽  
Coagulation Test ◽  
Elective Cardiac Surgery ◽  
Abnormal Bleeding

Background Abnormal bleeding after cardiopulmonary bypass (CPB) is a common complication of cardiac surgery, with important health and economic consequences. Coagulation test-based algorithms may reduce transfusion of non-erythrocyte allogeneic blood in patients with abnormal bleeding. Methods The authors performed a randomized prospective trial comparing allogeneic transfusion practices in 92 adult patients with abnormal bleeding after CPB. Patients with abnormal bleeding were randomized to one of two groups: a control group following individual anesthesiologist's transfusion practices and a protocol group using a transfusion algorithm guided by coagulation tests. Results Among 836 eligible patients having all types of elective cardiac surgery requiring CPB, 92 patients developed abnormal bleeding after CPB (incidence, 11%). The transfusion algorithm group received less allogeneic fresh frozen plasma in the operating room after CPB (median, 0 units; range, 0-7 units) than the control group (median, 3 units; range, 0-10 units) (P = 0.0002). The median number of platelet units transfused in the operating room after CPB was 4 (range, 0-12) in the algorithm group compared with 6 (range, 0-18) in the control group (P = 0.0001). Intensive care unit (ICU) mediastinal blood loss was significantly less in the algorithm group. Multivariate analysis demonstrated that transfusion algorithm use resulted in reduced ICU blood loss. The control group also had a significantly greater incidence of surgical reoperation of the mediastinum for bleeding (11.8% vs. 0%; P = 0.032). Conclusions Use of a coagulation test-based transfusion algorithm in cardiac surgery patients with abnormal bleeding after CPB reduced non-erythrocyte allogeneic transfusions in the operating room and ICU blood loss.

scholarly journals Determining the Optimal Tranexamic Acid Dose for Cardiac Surgery With Cardiopulmonary Bypass: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Xiuxiu Xie ◽  
Siren Shi ◽  
Xinqi Cheng ◽  
Muya Lin ◽  
Lijian Chen
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Chest Tube ◽  
Control Group ◽  
Loading Dose ◽  
Risk Of Bleeding ◽  
Tube Output ◽  
Chest Tube Output

Abstract Background: Tranexamic acid (TXA) has been widely used to reduce the risk of bleeding in patients undergoing cardiac surgery. However, the clinical TXA dose that best reduces postoperative bleeding has not been determined. We evaluated the efficacy of two different doses of TXA using Thromboelastography (TEG) in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).Methods: One hundred and eleven patients who underwent primary cardiac valve replacement with CPB were enrolled in this study. Patients were randomly divided into three groups: T1, T2, and the control group. Patients in the TXA group would receive different TXA doses: 15 mg/kg loading dose followed by an infusion of 5 mg/kg/h until the completion of surgery (T1 group) or 6 mg/kg loading dose followed by an infusion of 3 mg/kg/h until the completion of surgery (T2 group). Pre-operative patient characteristics, intraoperative data, transfusions between and after surgery, chest tube output after surgery within two days, and outcome data were recorded.Results: Transfusion of blood products, blood loss, and chest tube output were significantly reduced in the T1 group compared with the control group (P< 0.05). Compared to the control group, the T2 group had similar results. Surgical time and length of intensive care unit (ICU) stay were significantly lower in the T1 and T2 groups compared to the control group (P< 0.05). No postoperative seizures occurred in all three patient groups.Conclusions: The use ofTranexamic acid was associated with a lower risk of bleeding compared to the control group. Both doses of tranexamic acid were effective to reduce blood loss as well as transfusions compared to the control group.

Cost-Benefit and Efficacy of Aprotinin Compared with ε-Aminocaproic Acid in Patients Having Repeated Cardiac Operations 

1997 ◽  
Vol 87 (6) ◽  
pp. 1373-1380 ◽  
Author(s):  
Elliott Bennett-Guerrero ◽  
Jonathan G. Sorohan ◽  
Miguel L. Gurevich ◽  
Paul E. Kazanjian ◽  
Roberto R. Levy ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Total Dose ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Cost Effective ◽  
Aminocaproic Acid ◽  
High Dose ◽  
Thoracic Drainage ◽  
Epsilon Aminocaproic Acid ◽  
Platelet Transfusions

Background Aprotinin and epsilon-aminocaproic acid are routinely used to reduce bleeding during cardiac surgery. The marked difference in average wholesale cost between these two drug therapies (aprotinin, $1,080 vs. epsilon-aminocaproic acid, $11) has generated significant controversy regarding their relative efficacies and costs. Methods In a multicenter, randomized, prospective, blinded trial, patients having repeated cardiac surgery received either a high-dose regimen of aprotinin (total dose, 6 x 10(6) kallikrein inactivator units) or epsilon-aminocaproic acid (total dose, 270 mg/kg). Results Two hundred four patients were studied. Overall (data are median [25th-75th percentiles]), aprotinin-treated patients had less postoperative thoracic drainage (511 ml [383-805 ml] vs. 655 ml [464-1,045 ml]; P = 0.016) and received fewer platelet transfusions (0 [range, 0-1] vs. 1 [range, 0-2]; P = 0.036). The surgical field was more likely to be considered free of bleeding in aprotinin-treated patients (44% vs. 26%; P = 0.012). No differences, however, were seen in allogeneic erythrocyte transfusions or in the time required for chest closure. Overall, direct and indirect bleeding-related costs were greater in aprotinin- than in epsilon-aminocaproic acid-treated patients ($1,813 [$1,476-2,605] vs. $1,088 [range, $511-2,057]; P = 0.0001). This difference in cost per case varied in magnitude among sites but not in direction. Conclusions Aprotinin was more effective than epsilon-aminocaproic acid at decreasing bleeding and platelet transfusions. Epsilon-aminocaproic acid, however, was the more cost-effective therapy over a broad range of estimates for bleeding-related costs in patients undergoing repeated cardiac surgery. A cost-benefit analysis using the lower cost of half-dose aprotinin ($540) still resulted in a significant cost advantage using epsilon-aminocaproic therapy (P = 0.022).

scholarly journals High-dose Aprotinin in Cardiac Surgery—A Prospective, Randomized Study

1994 ◽  
Vol 22 (5) ◽  
pp. 529-533 ◽  
Author(s):  
M. J. Swart ◽  
P. C. Gordon ◽  
P. B. Hayse-Gregson ◽  
R. A. Dyer ◽  
A. L. Swanepoel ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Placebo Group ◽  
Blood Loss ◽  
Artery Bypass ◽  
Randomized Study ◽  
Postoperative Blood Loss ◽  
High Dose ◽  
Maintenance Infusion ◽  
Transfusion Requirements ◽  
High Dose Aprotinin

Fifty patients undergoing primary coronary artery bypass surgery and 50 patients undergoing valve surgery received either high-dose aprotinin (2 million units loading dose, 2 million units added to the CPB prime, and 500,000 units/hr maintenance infusion) or placebo. Mean postoperative blood loss in the first six hours was reduced from 321 ml in the placebo group to 172 ml in the aprotinin group (95% confidence interval (CI) for difference = 95 to 189 ml). Seven patients in the placebo group and 16 patients in the aprotinin group did not require transfusion with homologous blood. This study adds to the growing body of evidence that the administration of high-dose aprotinin reduces blood loss and blood transfusion requirements associated with primary cardiac surgery.

Volatile anaesthetics added to cardiopulmonary bypass are associated with reduced cardiac troponin

Perfusion ◽  
2017 ◽  
Vol 32 (7) ◽  
pp. 547-553 ◽  
Author(s):  
Elena Bignami ◽  
Marcello Guarnieri ◽  
Marina Pieri ◽  
Francesco De Simone ◽  
Alcira Rodriguez ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Myocardial Necrosis ◽  
Perioperative Period ◽  
Cardiac Surgical Procedures ◽  
Control Group ◽  
Volatile Anaesthetics ◽  
Volatile Agents

Background: Every year, over 1 million cardiac surgical procedures are performed all over the world. Reducing myocardial necrosis could have strong implications in postoperative clinical outcomes. Volatile anaesthetics have cardiac protective properties in the perioperative period of cardiac surgery. However, little data exists on the administration of volatile agents during cardiopulmonary bypass. The aim of this study was to assess if volatile anaesthetics administration during cardiopulmonary bypass reduces cardiac troponin release after cardiac surgery. Materials and methods: We retrospectively analysed data from 942 patients who underwent cardiac surgery in a teaching hospital. The only difference between the groups was the management of anaesthesia during CPB. The volatile group received sevoflurane or desflurane while the control group received a combination of propofol infusion and fentanyl boluses. Patients who received volatile anaesthetics during cardiopulmonary bypass (n=314) were propensity-matched 1:2 with patients who did not receive volatile anaesthetics during CPB (n=628). Results: We found a reduction in peak postoperative troponin I, from 7.8 ng/ml (4.8-13.1) in the non-volatile group to 6.8 ng/ml (3.7-11.8) in the volatile group (p=0.013), with no differences in mortality [2 (0.6%) in the volatile group and 2 (0.3%) in the non-volatile group (p=0.6)]. Conclusions: Adding volatile anaesthetics during cardiopulmonary bypass was associated with reduced peak postoperative troponin levels. Larger studies are required to confirm our data and to assess the effect of volatile agents on survival.

Clinical application of a new ternary polymer, SEC-1 coat™, for pediatric cardiopulmonary bypass circuits: a prospective randomized pilot study

Perfusion ◽  
2020 ◽  
Vol 35 (8) ◽  
pp. 826-832
Author(s):  
Tomomi Hasegawa ◽  
Yoshihiro Oshima ◽  
Shinji Yokoyama ◽  
Asuka Akimoto ◽  
Yusuke Misaka ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Pilot Study ◽  
Interleukin 6 ◽  
Patient Characteristics ◽  
Serum Levels ◽  
Pediatric Cardiac Surgery ◽  
Interleukin 8 ◽  
Control Group ◽  
Platelet Counts

Objective: The use of biocompatible materials to reduce the systemic activation of inflammation and coagulation pathways is expanding rapidly. However, there have been few clinical studies of biocompatible circuits for pediatric cardiopulmonary bypass. This pilot study aimed to preliminarily evaluate the biocompatibility of SEC-1 coat™ (SEC) for cardiopulmonary bypass circuits in pediatric cardiac surgery. Methods: Twenty infants undergoing cardiac surgery for isolated ventricular septal defects at Kobe Children’s Hospital were assigned randomly to an SEC-coated (SEC group, n = 10) or heparin-coated (control group, n = 10) circuit. Perioperative data and the following markers were prospectively analyzed: platelet counts and interleukin-6, interleukin-8, C3a, β-thromboglobulin, and thrombin–antithrombin complex levels. Results: Neither patient characteristics nor postoperative clinical outcomes differed significantly between the SEC and control groups. Platelet counts markedly decreased during cardiopulmonary bypass in both groups, but were significantly better preserved in the SEC group. Fewer patients needed postoperative platelet transfusions in the SEC group. After cardiopulmonary bypass termination, serum levels of β-thromboglobulin and thrombin–antithrombin complex were significantly lower in the SEC than in the control group. Although the differences were not statistically significant, serum levels of interleukin-6, interleukin-8, and C3a had a tendency toward being lower in the SEC group, with good preservation of leukocyte counts, fibrinogen, and antithrombin III. Conclusion: SEC-1 coat™ for cardiopulmonary bypass circuits have good biocompatibility with regard to platelet preservation and in terms of attenuating inflammatory reaction or coagulation activation during pediatric cardiac surgery. It can be beneficial in pediatric as well as adult cardiac surgery.

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