Maineri P, Covaia G, Realini M, Caccia G, Ucussich E, Luraschi M, Crosta A, Foresti B, Chiaranda M
Dipartimento di Anestesia e Rianimazione Università degli Studi dell'Insubria, Varese.
Minerva Cardioangiol. 2000 Jun;48(6):155-60.
Microvascular bleeding after Cardiopulmonary bypass (CPB) is mainly due to consumption of clotting factors, platelets damage, and hyperfibrinolysis. Aprotinin, the only antifibrinolytic drug effective in preserving platelets, is no longer available; an alternative regimen based on pure antifibrinolytic drugs has been proposed, since hyperfibrinolysis is known to contribute both to clot lysis and platelet dysfunction. In this study the efficacy of two antifibrinolytic drugs, Tranexamic acid (TA) and epsilon-aminocaproic acid (EACA), was tested in patients undergoing cardiopulmonary bypass (CPB), for primary myocardial revascularization.
Forty-eight consecutive patients were randomized to receive prophylactically equipotent doses of EACA (group A) or TA (Group B). Platelet count, prothrombin time, fibrin digestion products, blood loss and transfusion requirements recorded after 6 and 24 hours from the end of surgery were compared.
The two groups were comparable for length of CPB and numbers of grafts; no significant difference was observed in the coagulation parameters considered. Blood losses were less in group B (TA) than in group A (EACA), both at 6 and 24 hours after surgery; homologous blood transfused was also less in group B, but no difference was statistically significant. No adverse effect was observed.
In coronary patients, TA and EACA exhibit the same effects on blood loss and requirements after CPB; either drug can be safely used in cardiac surgery.
体外循环（CPB）后的微血管出血主要是由于凝血因子消耗、血小板损伤和高纤维蛋白溶解。抑肽酶是唯一一种对保存血小板有效的抗纤维蛋白溶解药物，现已不再可用；由于已知高纤维蛋白溶解会导致血栓溶解和血小板功能障碍，因此提出了一种基于纯抗纤维蛋白溶解药物的替代方案。在本研究中，测试了两种抗纤维蛋白溶解药物氨甲环酸（TA）和ε-氨基己酸（EACA）在接受体外循环（CPB）进行初次心肌血运重建的患者中的疗效。
48例连续患者被随机分配预防性接受等效剂量的EACA（A组）或TA（B组）。比较术后6小时和24小时记录的血小板计数、凝血酶原时间、纤维蛋白降解产物、失血量和输血需求。
两组在CPB时间和移植血管数量方面具有可比性；在所考虑的凝血参数方面未观察到显著差异。术后6小时和24小时，B组（TA）的失血量均少于A组（EACA）；B组输注的同源血量也较少，但差异无统计学意义。未观察到不良反应。
在冠心病患者中，TA和EACA对CPB后的失血量和需求表现出相同的影响；两种药物均可安全用于心脏手术。
