Epsilon-aminocaproic acid improves postrecirculation hemodynamics by reducing intraliver activated protein C consumption in orthotopic liver transplantation.
Kong HY, Wen XH, et al.World Journal of Surgery 2014 Jan;38(1):177-85.
Aims
To investigate if epsilon-aminocaproic acid (EACA) could improve hemodynamic stability after reperfusion and whether this is associated with less intraliver activated protein C (APC) consumption.
Interventions
Patients received either EACA or saline.
Participants
59 recipients undergoing liver transplantation.
Outcomes
The outcomes included protein c, APC, hemoglobin, hemacrit level and coagulation parameters including platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin degradation products and thrombin-activatable fibrinolysis inhibitor.
Follow-up
3 days
CET Conclusions
The anti-fibrinolysis agent Epsilon-aminocaproic acid (EACA) was tested in liver transplantation to see if it could reduce protein C activation and subsequent post-reperfusion syndrome compared to placebo. There was no difference in observed post-operative complications or patient survival in the first 30 days. Fibrin degradation products were reduced by EACA. No transhepatic differences in protein C were found in either group, however activated protein C levels in the caval effluent increased significantly in the EACA treated group. Blood loss was lower in the EACA treated group (1.9L versus 2.8L mean) and patients in the control group had lower mean arterial pressure after reperfusion and required more inotropes and blood products. Whilst there may be potential benefits of EACA administration there are risks associated with related hypercoagulable states and the mechanism of action of EACA upon activated protein C consumption is not fully understood.
Data analysis
Per protocol analysis
Trial registration
Not reported.