Anti-fibrinolytic therapy with aminocaproic acid for the control of bleeding in thrombocytopenic patients

Abstract

11 courses of EACA were given to 9 acutely ill, severely thrombocytopenic patients (platelet count less than 20 X 10(9)/l). 6 patients were being treated for acute leukaemia while 1 each had cyclical amegakaryocytic thrombocytopenia, dysmyelopoietic syndrome and advanced chronic lymphocytic leukaemia. 8 were refractory to HLA-matched platelets and 1 refused blood product transfusion. All had simultaneous major medical complications such as infection and granulocytopenia. The highest dose of EACA used was 24 mg/d. Improvement in haemostasis was noted in all patients with successful control of epistaxis in 1, control of gastrointestinal bleeding in 3 and lack of significant bleeding for 4-29 d in the remaining 5 patients. The only toxicity was dose-related nausea. Since this patient group was at extremely high risk for haemorrhage, we conclude that EACA is safe and useful in the management of thrombocytopenia including that occurring during leukaemic induction.