Original article| Volume 7, ISSUE 4, P431-435, August 1993

Prevention of postbypass bleeding with tranexamic acid and ϵ-aminocaproic acid

      This paper is only available as a PDF. To read, Please Download here.


      In this institution, two antifibrinolytic agents have been in routine use before cardiopulmonary bypass (CPB) to prevent bleeding due to fibrinolysis; ϵ-aminocaproic acid (EACA) or tranexamic acid (TA) are administered as intravenous infusions over 2 hours, from the time of anesthetic induction until the onset of CPB. TA is 10 times more potent and binds more strongly to plasminogen than EACA. Data were collected retrospectively on 411 patients undergoing first-time coronary artery bypass grafting with cardiopulmonary bypass who had received one of four therapy regimens: 10 g of EACA (65 patients), 15 g of EACA (60 patients), 6 g of TA (100 patients), or 10 g of TA (75 patients). Patients who did not receive any drug (91) served as controls. Anesthestic technique and the heparin/protamine protocol did not differ. Blood collected by mediastinal and pleural tubes was auto transfused up to 6 hours postoperatively. Both TA and EACA reduced post-CPB bleeding in the first 24 hours. Ten grams of TA was the most effective, resulting in a 52% and 36% reduction in blood loss over controls at 6 and 24 hours, respectively. Although 10 g of TA was more effective than 6 g of TA in blood loss control for the first 6 hours, the difference was not significant at 24 hours. A significantly lower number of patients in the 10 g TA group received blood products than in control (28% v 49%) patients (P = 0.02). Pretreatment with 10 g of TA prevented excessive (over 750 mL in 6 hours) bleeding after CPB.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Cardiothoracic and Vascular Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Talamonti M.S.
        • LoCicero III, J.
        • Hoyne W.P.
        • et al.
        Early reexploration for excessive postoperative bleeding lowers wound complication rates in open heart surgery.
        Am Surg. 1987; 53: 102-104
        • Mori F.
        • Nakahara Y.
        • Kurata S.
        • et al.
        Late changes in hemostatic parameters following open heart surgery.
        J Cardiovasc Surg. 1982; 23: 458-462
        • Bick R.L.
        Hemostatic defects associated with cardiac surgery, prosthetic devices, and extracorporeal circuits.
        Semin Thromb Hemost. 1985; 11: 249-280
        • Bagge L.
        • Lilienberg G.
        • Nystrom S.O.
        • Tyden H.
        Coagulation, fibrinolysis, and bleeding after open-heart surgery.
        Scand J Thor Cardiovasc Surg. 1986; 20: 151-160
        • Kucuk O.
        • Kwaan H.C.
        • Frederickson J.
        • et al.
        Increased fibrinolytic activity in patients undergoing cardiopulmonary bypass operation.
        Am J Hematol. 1986; 23: 223-229
        • Holloway D.S.
        • Summaria L.
        • Sandesara J.
        • et al.
        Decreased platelet number and function and increased fibrinolysis contribute to postoperative bleeding in cardiopulmonary bypass patients.
        Thromb Haemost. 1988; 59: 62-67
        • Lambert C.J.
        • Marengo-Rowe A.J.
        • Leveson J.E.
        • et al.
        The treatment of postperfusion bleeding using ϵ-aminocaproic acid, cryoprecipitate, fresh-frozen plasma, and protamine sulfate.
        Ann Thorac Surg. 1979; 28: 440-445
        • McNicol G.P.
        • Fletcher A.P.
        • Alkjaesig N.
        • Sherry S.
        The absorption, distribution, and excretion of E-aminocaproic acid following oral and intravenous administration in man.
        J Lab Clin Med. 1962; 59: 15-24
        • Eriksson O.
        • Kjellman H.
        • Pilbrant A.
        • Schannong M.
        Pharmacokinetics of tranexamic acid after intravenous administration to normal volunteers.
        Europ J Clin Pharmacol. 1974; 7: 375-380
        • Markwardt F.
        • Nowak G.
        • Meerbah W.
        • Rudiger K.S.
        The influence of drugs on disseminated intravascular coagulation (DIC). I. Effects of antifibrinolytics and fibrinolytics on thrombin-induced DIC in rats.
        Thromb Res. 1976; 9: 143-152
        • Teoh K.H.
        • Christakis G.T.
        • Weisel R.D.
        • et al.
        Dipyridamole preserved platelets and reduced blood loss after cardiopulmonary bypass.
        J Thorac Cardiovasc Surg. 1988; 96: 332-341
        • Verstraete M.
        Clinical application of inhibitors of fibrinolysis.
        Drugs. 1985; 29: 236-261
        • DelRossi A.J.
        • Cernaianu A.C.
        • Botros S.
        • et al.
        Prophylactic treatment of postperfusion bleeding using EACA.
        Chest. 1989; 96: 27-30
        • Sterns L.P.
        • Lillehei C.W.
        Effect of epsilon-aminocaproic acid upon blood loss following open-heart surgery: An analysis of 340 patients.
        Canad J Surg. 1967; 10: 304-397
        • Horrow J.C.
        • Hlavacek J.
        • Strong M.D.
        • et al.
        Prophylactic tranexamic acid decreases bleeding after cardiac operations.
        J Thorac Cardiovasc Surg. 1990; 99: 70-74
        • Gram J.
        • Janetzki T.
        • Jespersen J.
        • Bruhn H.
        Enhanced effective fibrinolysis following the neutralization of heparin in open-heart surgery increases the risk of post-surgical bleeding.
        Thromb Haemot. 1990; 63: 241-245
        • Mannucci P.M.
        • Canciani M.T.
        • Tora L.
        • Donovan B.S.
        Response of factor VIII /von Willebrand factor to DDAVP in healthy subjects and patients with hemophilia A and von Willebrand's disease.
        Br J Haematol. 1981; 47: 283-293
        • Vander Sahn T.J.
        • Ansell J.E.
        • Okike O.N.
        • et al.
        The role of ϵ-aminocaproic acid in reducing bleeding after cardiac operation: A double-blind randomized study.
        J Thorac Cardiovasc Surg. 1988; 95: 538-540
        • Mammen E.F.
        • Koets M.H.
        • Washington B.C.
        • et al.
        Hemostasis changes during cardiopulmonary bypass surgery.
        Semin Thromb Hemost. 1985; 11: 281-292
        • Harker L.A.
        • Malpass T.W.
        • Branson H.E.
        • et al.
        Mechanisms of abnormal bleeding in patients undergoing cardiopulmonary bypass. Acquired transient platelet dysfunction associated with selective a-granule release.
        Blood. 1980; 56: 824-834
        • Hoffman E.P.
        • Koo A.H.
        Cerebral thrombosis associated with Amicar.
        Radiology. 1979; 131: 687-689
        • Naeye L.
        Thrombotic state after hemorrhagic diathesis, a possible complication of therapy with E-aminocaproic acid.
        Blood. 1962; 19: 694-701
        • Rydin E.
        • Lundberg P.O.
        Tranexamic acid and intracranial thrombosis.
        Lancet. 1976; 2: 49-51
        • Sonntag V.K.H.
        • Stein B.M.
        Arteriopathic complications during treatment of subarachnoid hemorrhage with ϵ-aminocaproic acid.
        J Neurosurg. 1974; 40: 480-485
        • Davies D.
        • Howell D.A.
        Tranexamic acid and arterial thrombosis.
        Lancet. 1977; 1: 49-51
        • Lewis J.H.
        • Doyle A.P.
        Effects of E-aminocaproic acid on coagulation and fibrinolysic mechanisms.
        JAMA. 1964; 188: 56-63
        • Woo K.S.
        • Tse L.K.K.
        • Woo J.L.F.
        • Valiance-Owen J.
        Massive pulmonary thromboembolism after tranexamic acid antifibrinolytic therapy.
        Br J Clin Pract. 1989; 43: 465-466