Bennett-Guerrero E, Spillane W F, White W D, Muhlbaier L H, Gall S A, Smith P K, Newman M F
Department of Anesthesiology, The Mount Sinai Medical Center, New York, New York 10029-6574, USA.
Ann Thorac Surg. 1999 May;67(5):1283-7. doi: 10.1016/s0003-4975(99)00116-2.
Epsilon-aminocaproic acid is routinely used to reduce bleeding during cardiac surgery. Anecdotal reports of thrombotic complications have led to speculation regarding this drug's safety. We investigated the association between epsilon-aminocaproic acid administration and postoperative stroke.
Six thousand two hundred ninety-eight patients undergoing isolated coronary artery bypass graft surgery between 1989 and 1995 were studied. Data was obtained from the Duke Cardiovascular Database as well as from an automated intraoperative anesthesia record keeper. Patients identified as having postoperative stroke were reviewed and confirmed by a board certified neurologist blinded to epsilon-aminocaproic acid administration.
Postoperative stroke occurred in 97 patients (1.5%). Three thousand one hundred thirty-five (49.8%) patients received epsilon-aminocaproic acid. Increased age was associated with a higher incidence of postoperative stroke (p = 0.0001). In contrast, there was no significant difference (p = 0.7370) in the incidence of stroke between use of epsilon-aminocaproic acid (1.3%) and nonuse (1.7%). Multivariable logistic regression found no significant effect of epsilon-aminocaproic acid use on stroke after accounting for age, date of surgery, and history of diabetes.
This series suggests that epsilon-aminocaproic acid administration does not increase the risk of postoperative stroke.
ε-氨基己酸常用于减少心脏手术期间的出血。关于血栓形成并发症的轶事报道引发了对该药物安全性的猜测。我们调查了使用ε-氨基己酸与术后中风之间的关联。
研究了1989年至1995年间接受单纯冠状动脉旁路移植手术的6298例患者。数据来自杜克心血管数据库以及自动术中麻醉记录保存器。对确定为术后中风的患者进行复查，并由一名对ε-氨基己酸使用情况不知情的董事会认证神经科医生进行确认。
97例患者（1.5%）发生术后中风。3135例（49.8%）患者使用了ε-氨基己酸。年龄增加与术后中风发生率较高相关（p = 0.0001）。相比之下，使用ε-氨基己酸（1.3%）和未使用（1.7%）的患者中风发生率无显著差异（p = 0.7370）。多变量逻辑回归分析发现，在考虑年龄、手术日期和糖尿病史后，使用ε-氨基己酸对中风无显著影响。
该系列研究表明，使用ε-氨基己酸不会增加术后中风的风险。
