High-Dose ϵ-Aminocaproic Acid Versus Aprotinin: Antifibrinolytic Efficacy in First-Time Coronary Operations Balthasar Eberle, Eckhard Mayer, Gerhard.

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High-Dose ϵ-Aminocaproic Acid Versus Aprotinin: Antifibrinolytic Efficacy in First-Time Coronary Operations Balthasar Eberle, Eckhard Mayer, Gerhard Hafner, Jens Heinermann, Manfred Dahm, Winfried Prellwitz, Wolfgang Dick, Hellmut Oelert The Annals of Thoracic Surgery Volume 65, Issue 3, Pages 667-673 (March 1998) DOI: 10.1016/S0003-4975(97)01424-0

Fig. 1 Thrombin-antithrombin complex levels increase until termination of cardiopulmonary bypass (CPB) in all patients. Thereafter, the thrombin-antithrombin complex remains elevated for 12 postoperative hours in untreated patients, more than in patients receiving aprotinin or ϵ-aminocaproic acid (ϵ-ACA) (∗p < 0.05 versus aprotinin or ϵ-aminocaproic acid). Box plot shows medians, interquartile ranges (boxes), and 10th/90th percentiles (whiskers). The Annals of Thoracic Surgery 1998 65, 667-673DOI: (10.1016/S0003-4975(97)01424-0)

Fig. 2 Perioperative profiles of fibrinogen-fibrin split products (A) and, specifically, d-dimers (B). Both aprotinin and ϵ-aminocaproic acid (ϵ-ACA) effectively suppress their appearance. Untreated patients show highly elevated levels of fibrinolytic products (∗p < 0.0001 versus active drugs). Data are means ± standard errors. The Annals of Thoracic Surgery 1998 65, 667-673DOI: (10.1016/S0003-4975(97)01424-0)

Fig. 3 Perioperative profile of antiplasmin-plasmin complex levels. Patients treated with ϵ-aminocaproic acid (ϵ-ACA) show a significant increase of about 12 hours (∗p < 0.02 versus control). Aprotinin is most effective in suppressing antiplasmin-plasmin complex generation (∗∗p < 0.0001 versus ϵ-aminocaproic acid). Data are means ± standard errors. The Annals of Thoracic Surgery 1998 65, 667-673DOI: (10.1016/S0003-4975(97)01424-0)

Fig. 4 Four-hourly (bars) and cumulative (lines) postoperative thoracic drainage in first-time coronary artery bypass patients treated with either aprotinin, ϵ-aminocaproic acid (ϵ-ACA), or untreated controls. Both antifibrinolytics are highly effective (∗∗p < 0.001 versus control). For 4 hours after completion of drug infusion, aprotinin reduces drainage transiently more than ϵ-aminocaproic acid (∗p < 0.02 versus ϵ-aminocaproic acid or control). Cumulative 24-hour analysis is not sensitive enough to recognize this difference. Graph shows means ± standard errors. The Annals of Thoracic Surgery 1998 65, 667-673DOI: (10.1016/S0003-4975(97)01424-0)