Decreased postoperative drainage with addition of epsilon-aminocaproic acid before cardiopulmonary bypass

Abstract

Desmopressin (DDAVP, 0.3 microgram/kg) has been used routinely after cardiopulmonary bypass, particularly in patients having antiplatelet therapy. Recently epsilon-aminocaproic acid (single dose of 5 g) given before cardiopulmonary bypass has been added to the protocol. One hundred consecutive patients taking desmopressin and epsilon-aminocaproic acid (group A) and another 100 taking desmopressin alone (group B) were analyzed. There was no difference among these two groups in patient age, sex, preoperative history of bleeding and drug consumption, or number of patients for elective, urgent, emergent, redo, and reoperation for bleeding. Results of routine preoperative coagulation studies were within normal limits in both groups. Preoperative hemoglobin level was 13.5 g/dL in group A and 13.8 g/dL in group B (p = 0.12). Estimated blood loss in the operating room was 513 mL for group A and 587 mL for group B (p = 0.07). The total chest drainage at the end of 24 hours was 492 mL in group A and 746 mL in group B (p = 0.0001). Amicar given before cardiopulmonary bypass does not lessen operating room blood loss, but significantly decreases postoperative chest drainage. Group B patients received more fresh frozen plasma (60 U versus 4 U), more platelets (130 U versus 16 U), and more cryoprecipitate (118 U versus 10 U) than group A patients. Adding epsilon-aminocaproic acid could save $206.18 in blood product use per patient, compared with the expense of $24.12 per patient for E-aminocaproic acid administration.