Hello!!!

Thank you so much for suggesting this article.

I found it quite interesting and I think it answers many questions asked by my colleagues.

In relation to the protocols used by other institutions of EACA, I think this is one of the most commonly used.

Greetings from Moldova,

V. Savan

Hello,

We at our hospital use EACA in adult cardiac surgical patients like in coronary artery bypass graft surgery and valvular heart surgery 100mg/kg before skin incision and repeated at start of cardiopulmonary bypass into the pump reservoir. However in congenital heart surgerical patients another dose of 100mg/kg after reversal of heparin with protamine. We avoid EACA in patients of mitral stenosis with spontaneous echocontrast.

Greetings from India

Neeti Makhija

The benefit of its use in cardiac surgery is well known in term of blood protection. We used aprotinin but as you know we do not now. we don't have much experience about EACA but we can use EACA according to your protocol if it is well established.

To Dr. Neeti Makhija, thank you for your answer, it is kind interesting. But i'd like to ask you what is the reason to avoid EACA in mitral stenosis? And what type of antifibrinolytic do you use in this case?

Veaceslav SAVAN

To Moritz Kretzschmar. Many thanks for your information. We discussed with my collegues about the protocole used in this study. But, again, we don't have yet TXA... Other colleagues suggest to use the same dose of EACA but multiplied by 10. The same type of molecule and same mecanism of inhibition of finbrinolysis.

Thank you a lot for your interest.

Veaceslav SAVAN

I avoid use of EACA in patients of severe mitral stenosis with dense spontaneous echocontrast in the pre CPB period as it is associated with risk of thromboembolism. Although possibility of thrombolic complication with EACA is low otherwise but still in this situation it can be potential. I don't use any other antifibrinolytic in its place.

Interesting approach. Thank you very much

Hi Slavi,

Thanks for the interesting discussion. I think the question is not if antifibrinolytic agents should be systematically used or not, because the provocative answer would be YES. The question is how much do you need to give to safely inhibit fibrinolysis without increase in risk of side effects?

EACA has been used for a while but is not used anymore in most of the countries. EACA was used in the well-known BART study (NEJM 2008) at the dose of 10000 mg followed by continuous infusion of 2000 mg per hours. This drug is not well known, especially the pharmacokinetics. Maybe the dose scheme used in the BART study is really much higher than we could recommend. Some interesting PK studies appear in the literature (as noted) but there is still a lack of PK/PD assessment for EACA in cardiac surgery.

Best regards.

David

Hi David,

Thanks so much for your detailed response. I agree with you that it is essential to use anti-fibrinolytics in cardiac surgery.

Obviously, as you mentioned already, the EACA is least used and I think that shows a lower interest to be studied in more detail.

In our institution is trying to adjust doses of EACA to ensure effective inhibition of fibrinolysis. Latest research shows interest in diminishing doses of these drugs.

Best regards.

Slavi

We are using tranexamic acid locally in the intrapericardial cavity, just before closing the sternum, and results are quite encouraging regarding post op bleeding.

Veaceslav,

look at this excellent report. I know you have no access to TXA but you will find studies mentioning EACA too. Its mainly focused on kids by the way

http://www.hma.eu/fileadmin/dateien/Human_Medicines/CMD_h_/Paediatric_Regulation/Assessment_Reports/Article_45_work-sharing/Tranexamic_acid_45PaedAR.pdf

Thanks

For sharing