Pinosky M L, Kennedy D J, Fishman R L, Reeves S T, Alpert C C, Ecklund J, Kribbs S, Spinale F G, Kratz J M, Crawford R, Gravlee G P, Dorman B H
Department of Anesthesia, Medical University of South Carolina, Charleston 29425-2207, USA.
J Card Surg. 1997 Sep-Oct;12(5):330-8. doi: 10.1111/j.1540-8191.1997.tb00147.x.
Perioperative bleeding following coronary artery bypass grafting (CABG) is associated with increased blood product usage. Although aprotonin is effective in reducing perioperative blood loss, excessive cost prohibits routine utilization. Epsilon aminocaproic acid (EACA) and tranexamic acid (TA) are inexpensive antifibrinolytic agents, which, when given prophylactically, may reduce blood loss. The present study was undertaken to compare the efficacy of TA and EACA in reducing perioperative blood loss.
The study population consisted of first-time CABG patients. Patients were allocated in a prospective double-blind fashion: (1) group EACA (loading dose 15 mg/kg, continuous infusion 10 mg/kg per hour for 6 hours, N = 20); (2) group TA (loading dose 15 mg/kg, continuous infusion 1 mg/kg per hour for 6 hours, N = 20); (3) control group (infusion of normal saline for 6 hours, N = 19).
Treatment groups were similar preoperatively. No significant difference in intraoperative blood loss or perioperative use of blood products was noted. D-dimer concentration was elevated in the control group compared to the EACA and TA groups (p < 0.05). Group TA had less postoperative blood loss than the EACA and control groups at 6 and 12 hours postoperatively (p < 0.05). TA had reduced total blood loss (600 +/- 49 mL) postoperatively compared to EACA (961 +/- 148 mL) and control (1060 +/- 127 mL, p < 0.05).
TA and EACA effectively inhibited fibrinolytic activity intraoperatively and throughout the first 24 hours postoperatively. TA was more effective in reducing blood loss postoperatively following CABG. This suggests that TA may be beneficial as an effective and inexpensive antifibrinolytic in first-time CABG patients.
冠状动脉旁路移植术（CABG）围手术期出血与血液制品使用增加有关。尽管抑肽酶在减少围手术期失血方面有效，但成本过高禁止常规使用。ε-氨基己酸（EACA）和氨甲环酸（TA）是廉价的抗纤溶药物，预防性给药时可能减少失血。本研究旨在比较TA和EACA在减少围手术期失血方面的疗效。
研究人群包括首次行CABG的患者。患者以前瞻性双盲方式分组：（1）EACA组（负荷剂量15mg/kg，持续输注10mg/kg每小时，共6小时，N = 20）；（2）TA组（负荷剂量15mg/kg，持续输注1mg/kg每小时，共6小时，N = 20）；（3）对照组（输注生理盐水6小时，N = 19）。
治疗组术前情况相似。术中失血量或围手术期血液制品使用无显著差异。与EACA组和TA组相比，对照组D-二聚体浓度升高（p < 0.05）。术后6小时和12小时，TA组术后失血量少于EACA组和对照组（p < 0.05）。与EACA组（961 +/- 148 mL）和对照组（1060 +/- 127 mL）相比，TA组术后总失血量减少（600 +/- 49 mL，p < 0.05）。
TA和EACA在术中及术后最初24小时内有效抑制纤溶活性。TA在CABG术后减少失血方面更有效。这表明TA作为一种有效且廉价的抗纤溶药物，对首次行CABG的患者可能有益。
