[The efficacy and safety of tranexamic acid and epsilon-aminocapronic acid in cardiac surgery under extracorporeal circulation].

Sixty patients who had undergone cardiosurgical operations under extracorporeal circulation (EC) were enrolled in the study. All the patients were divided into 2 groups: (1) 40 patients were injected tranexamic acid (TA) (its loading dose was 15 mg/kg; maintenance infusion 1 mg/kg/h throughout the operation; 500 mg in the primary packing volume for an EC apparatus (EA); (2) 20 patients received epsilon-aminocapronic acid (ACA) (its loading dose was 5 g; 5 g in the primary packing volume for an EA and 10 g for infusion after EC). The effects of TA and ACA on the fibrinolytic system were evaluated from the time of XIIa-kallikrein-dependent fibrinolysis (sec) and the concentration of D-dimer (mg/ml). The hemocoagulation system (activated partial thromboplastin time, thrombin clotting time, prothrombin time with the determination of the international normalized ratio, fibrinogen) was studied. The thromboelastogram (the time R, K, and alpha-angle, MA) was analyzed. The indices were determined at the beginning and end of, and 12 hours after surgery. The analysis of the clinical efficacy and safety of the agents was based on the following perioperative data: the incidence of adverse reactions and complications associated with the administration of the agents, the frequency and amount of transfused donor blood components, the volume of blood loss, and the rate of resternotomies. The laboratory and clinical findings lead to the conclusion that TA (Tranexam, OOO "MIR-PHARM") has a 4-fold antifibrinolytic activity as compared with epsilon-ACA. The more pronounced TA-induced suppression of fibrinolysis affects the clinical course of a perioperative period in this group, which manifests itself as a reduced blood loss volume during and after surgery and a lower frequency of use of donor blood elements. By taking into account these data, TA may be recommended as one of the blood-preserving technology components during cardiosurgical operations under EC.