Effect of prophylactic epsilon aminocaproic acid on blood loss and transfusion requirements in patients undergoing first-time coronary artery bypass grafting. A randomized, prospective, double-blind study

LITERATURE REVIEW Frederick W. Campbell, MD, Section Editor

SCIENTIFIC ARTICLES

Daily PO, Lamphere JA, Dembitsky WP, et ah Effect of prophylactic epsilon aminocaproic acid on blood loss and transfusion requirements in patients undergoing first-time coronary artery bypass grafting. A randomized, prospective, double-blind study. J Thorac Cardiovasc Surg 108:99-108, 1994 Forty patients undergoing primary myocardial rcvascularizahon received epsdon ammocaprolc acid, 30 g (10 g before skin incision, 10 g m the pump, and 10 g after protamine administration), or placebo Postoperative blood loss, transfusion requirement, Ddlmers, and fibrin split products were significantly reduced in the epsilon aminocaprolc acid group compared with controls The results are comparable with those obtained by use of tranexamlc acid or aprotmm m other studies

Gurevitch J, Barak J, Hochhauser E, et ah Aprotinin improves myocardial recovery after ischemia and reperfusion. Effects of the drug on isolated rat hearts. J Thorac Cardiovasc Surg 108:109-118, 1994 Isolated rat hearts were perfused with aprotinm (106 KIU/L) or normal saline for 30 minutes before a 40-minute period of global ischemia and during 2 minutes of crystallold cardioplegia at the onset of ischemia. On reperfusion, aprotinm-treated hearts had better contractility, higher coronary flow, and lower creatlnine levels than did controls. In normal nomschemlc perfused hearts, administration of aprotlnm during the preliminary study phase produced no differences m myocardial performance compared to a control group.

Uren NG, Melin JA, De Bruyne B, et al: Relation between myocardial blood flow and the severity of coronary artery stenosis. N Engl J Med 330:17821788, 1994 Myocardial blood flow was measured by positron emission tomography at rest and during adenosine- or dipyndamoleinduced hyperemla in 35 patients with single-vessel coronary disease and 21 age-matched controls. Basal myocardial blood flow was similar in both patient groups, and in patients with coronary artery disease, unaffected by the seventy of stenosls. During hyperemia, myocardial blood flow increased to a greater level in controls than in patients. Myocardial flow during hyperemla correlated inversely and significantly with the degree of stenosls when the degree of stenosis was >40% Coronary vasodllator reserve (ratio of flow during hyperemia to flow at basehne) began to decline when the degree of stenosIs was 40% and approached unity when stenosis was greater than or equal to 80%

McLaughlin DP, Belier GA, Linden J, et ah Hemo-

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dynamic and metabolic correlates of dipyridamoleinduced myocardial thallium-201 perfusion abnormalities in multivessel coronary artery disease. Am J Cardiol 74:1159-1164, 1994 Dipyridamole thallium imaging was simultaneously performed with serial electrocardiographic, hemodynamic, and aortic and coronary sinus lactate monitoring in 17 patients with anglographically determined coronary artery disease (CAD) and in 6 patients with normal coronary arteries All patients with coronary disease had thallium redistribution defects, all normal patients had normal scans. Mean arterial and pulmonary artery wedge pressures were similar in both groups and did not change m response to dipyrldamole Myocardial lactate extraction was similar at baseline and decreased similarly in both groups Coronary sinus adenosine concentration was higher at baseline in patients with CAD (presumably reflecting maintenance of resting coronary blood flow by endogenous adenosine) and Increased comparably in both groups after dipyrIdamole Dlpyridamole-thalhum imaging demonstrated regional differences in flow reserve m patients with CAD but did not produce myocardial ischemla by hemodynamic and metabolic criteria measured

Prince CR, Stoddard MF, Forrest GT, et al: Dobutamine two-dimensional transesophageal echocardiographic stress testing for detection of coronary artery disease. Am Heart J 128:36-41, 1994 Left ventrlcular regional wall motion was assessed by transesophageal echocardlography in 81 adult pahents Ischemla was diagnosed by development of severe hypokinesis, aklnesis, or dyskmesis of a previously contractile segment. On coronary anglography, 21 patients had significant coronary artery disease. Dobutamine stress transesophageal echocardiography achieved a sensitivity of 90% and speoficlty of 94% for detection of coronary artery disease In patients with previous coronary artery surgery (iV = 8), the sensitivity and specificity for the detection of bypass graft stenosls were 100% and 75%, respectively Atrial pacing and dlpyrldamole transesophageal echocardiography have also been shown to be sensitive and specific tests for coronary artery disease

Mahmarian J J, Fenimore NL, Marks GF, et al: Transdermal nitroglycerin patch therapy reduces the extent of exercise-induced myocardial ischemia: Resuits of a double-blind placebo-controlled trial using quantitative thallium-201 tomography. J Am Coil Cardio124:25-32, 1994 Forty patients were randomized to receive nitroglycerin patch therapy (0 4 mg) or placebo before baseline treadmill exercise and thaUxum-201 tomography Exerose tomography was repeated 6 days later after apphcation of therapy or placebo Transdermal nitroglycerin patch patients had a significant reduction in thelr total perfusxon defect size ( - 8 9%) compared with placebo-

Journal of Cardlothoractc and Vascular Anesthesia, Vol 9, No 1 (Februa ry), 1995 p p 106-108