J Anesth Perioper Med. 2018;5(4):169-175. https://doi.org/10.24015/ebcmed.japm.2018.0071

Blood Conservation Using Tranexamic Acid versus Epsilon Aminocaproic Acid in Cardiac Surgery: A Randomized Controlled Trial

Jason Gatling, Davinder Ramsingh, Justin Horricks, Ryan Lauer, Stanley Brauer, Johnthan Debooy, Carin Mascetti, and Richard Applegate

From the Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA, USA.

Correspondence to Dr. Davinder Ramsingh at dramsingh@llu.edu.

EBCMED ID: ebcmed.japm.2018.0071 DOI: 10.24015/ebcmed.japm.2018.0071


This study compares the efficacy of tranexamic acid (TXA) to epsilon aminocaproic acid (EACA) in reducing blood loss in patients undergoing cardiac surgery.

This was a double-blinded randomized trial. Patients (n = 100) undergoing cardiac surgery were randomized to receive either TXA (10 mg/kg bolus followed by an infusion of 1 mg/kg/hr) or EACA (150 mg/kg bolus followed by an infusion of 20 mg/kg/hr). The primary outcome measure was a difference in transfusion amounts. Secondary outcomes measured included: the amount of transfusion during the operative procedure, calculated Red blood cell (RBC) volume change, postoperative creatinine, time to extubation, chest tube output and length of ICU stay.

A total of 100 patients consented, of whom 82 completed participation in the study (EACA arm = 42 patients and TXA arm = 40 patients). There was no difference in patient demographics. Similarly, there was no difference between the type of cardiac surgery, cardiopulmonary bypass (CPB) time, intraoperative fluids, and procedure time. Primary marker comparison showed no difference in the frequency or amount of transfusion between groups in the operating room, ICU, or in total. Additionally, there was no difference in hematocrit (Hct), chest tube output, time to extubation, and length of stay. Post Hoc analysis indicated that red blood cell volume change through postoperative day 2 was larger in TXA than EACA; P = 0.03).

There was no difference in clinically significant outcome criteria between the TXA and EACA groups. Given the lower cost of EACA, this study further supports EACA as an appropriate antifibrinolytic agent for cardiac surgery. (Funded by the Department of Anesthesiology, Loma Linda University Medical Center; ClinicalTrials. gov number, NCT01248104.)

Article Type
Original Article

Declaration of Interests
The authors have no other potential conflicts of interest for this work.

This study was supported by the Department of Anesthesiology, Loma Linda University Medical Center.

This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.