TY - JOUR
T1 - ε-Aminocaproic acid plasma levels during cardiopulmonary bypass
AU - Bennett-Guerrero, Elliott
AU - Sorohan, Jonathan G.
AU - Canada, Andrew T.
AU - Ayuso, Liza
AU - Newman, Mark F.
AU - Reves, J. G.
AU - Mythen, Michael G.
PY - 1997/8
Y1 - 1997/8
N2 - ε-Aminocaproic acid (EACA) concentrations achieved during cardiopulmonary bypass (CPB) have not been previously reported. It is unknown whether plasma concentrations reported to inhibit fibrinolysis in vitro (130 μg/mL) are achieved or whether differences in these levels relate to variability in postoperative bleeding. EACA (total intraoperative dose 270 mg/kg) was administered to 27 patients undergoing cardiac reoperation. The plasma EACA concentration was measured by using high-pressure liquid chromatography: 1) 30 min after initiation of drug administration (baseline); 2) 30 min (CPB + 30) after initiation of CPB; 3) 90 min after initiation of CPB. (CPB + 90); and 4) at cardiopulmonary bypass termination (end CPB). Plasma EACA concentrations (μg/mL, min - max, mean ± 5D) were 276-998, 593 ± 154 at baseline; 147-527, 302 ± 95 at CPB + 30; 112-500, 314 ± 100 at CPB + 90; and 84-537, 317 ± 100 at end CPB. Twenty-four-hour postoperative thoracic drainage and allogeneic red blood cell transfusions were not associated with plasma levels at any time. Although plasma EACA concentrations greater than 130 μg/mL were consistently achieved, we observed a marked variability (more than sixfold) in plasma concentrations and bleeding outcomes despite the use of a weight-based dosing regimen. This variability in drug levels appears to have little relevance to bleeding outcomes, possibly since mean plasma levels exceeded 130 μg/mL during CPB, and nearly all patients (26 of 27) achieved that target level.
AB - ε-Aminocaproic acid (EACA) concentrations achieved during cardiopulmonary bypass (CPB) have not been previously reported. It is unknown whether plasma concentrations reported to inhibit fibrinolysis in vitro (130 μg/mL) are achieved or whether differences in these levels relate to variability in postoperative bleeding. EACA (total intraoperative dose 270 mg/kg) was administered to 27 patients undergoing cardiac reoperation. The plasma EACA concentration was measured by using high-pressure liquid chromatography: 1) 30 min after initiation of drug administration (baseline); 2) 30 min (CPB + 30) after initiation of CPB; 3) 90 min after initiation of CPB. (CPB + 90); and 4) at cardiopulmonary bypass termination (end CPB). Plasma EACA concentrations (μg/mL, min - max, mean ± 5D) were 276-998, 593 ± 154 at baseline; 147-527, 302 ± 95 at CPB + 30; 112-500, 314 ± 100 at CPB + 90; and 84-537, 317 ± 100 at end CPB. Twenty-four-hour postoperative thoracic drainage and allogeneic red blood cell transfusions were not associated with plasma levels at any time. Although plasma EACA concentrations greater than 130 μg/mL were consistently achieved, we observed a marked variability (more than sixfold) in plasma concentrations and bleeding outcomes despite the use of a weight-based dosing regimen. This variability in drug levels appears to have little relevance to bleeding outcomes, possibly since mean plasma levels exceeded 130 μg/mL during CPB, and nearly all patients (26 of 27) achieved that target level.
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U2 - 10.1097/00000539-199708000-00002
DO - 10.1097/00000539-199708000-00002
M3 - Article
C2 - 9249095
AN - SCOPUS:0030609812
SN - 0003-2999
VL - 85
SP - 248
EP - 251
JO - Anesthesia and Analgesia
JF - Anesthesia and Analgesia
IS - 2
ER -