ε-Aminocaproic acid administration and stroke following coronary artery bypass graft surgery

Background. ε-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 ε-aminocaproic acid administration and postoperative stroke. Methods. 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 ε-aminocaproic acid administration. Results. Postoperative stroke occurred in 97 patients (1.5%). Three thousand one hundred thirty-five (49.8%) patients received ε-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 ε-aminocaproic acid (1.3%) and nonuse (1.7%). Multivariable logistic regression found no significant effect of ε-aminocaproic acid use on stroke after accounting for age, date of surgery, and history of diabetes. Conclusions. This series suggests that ε- aminocaproic acid administration does not increase the risk of postoperative stroke.