ε-Aminocaproic acid inhibition of fibrinolysis in vitro: Should the 'therapeutic' concentration be reconsidered?

Vance G. Nielsen, Lana Cankovic, Brad L. Steenwyk

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

The therapeutic concentration of ε-aminocaproic acid (EACA) has been 130 μg/ml or greater for nearly 50 years. We tested the effects on clot growth/disintegration of EACA with a plasmatic model of hyperfibrinolysis in vitro. Human plasma was exposed to 1000 U/ml tissue-type plasminogen activator containing 0, 13, 65 or 130 μg/ml EACA, with clot growth/disintegration kinetics quantified via thrombelastography. Data were analyzed with one-way analysis of variance or Kruskal-Wallis analysis of variance as appropriate. Exposure of plasma to 1000 U/ml tissue-type plasminogen activator resulted in a brief-lived clot, lasting 2 min. EACA at all concentrations tested significantly increased the rate of clot growth compared with samples with 0 μg/ml EACA. Clot strength was significantly increased by EACA in a concentration-dependent fashion. Similarly, EACA significantly prolonged the time of onset of clot lysis and decreased the rate of lysis. Samples with 130 μg/ml EACA had no sign of lysis present for 30 min. Subtherapeutic to therapeutic concentrations of EACA significantly attenuated or abolished fibrinolysis in the presence of a concentration of tissue-type plasminogen activator more than 2000-fold that encountered systemically during cardiopulmonary bypass. Further clinical investigation is warranted to determine whether smaller concentrations of EACA could provide a reduction in bleeding with a concomitant decrease in thrombotic complications.

Original languageEnglish (US)
Pages (from-to)35-39
Number of pages5
JournalBlood Coagulation and Fibrinolysis
Volume18
Issue number1
DOIs
StatePublished - Jan 1 2007
Externally publishedYes

Keywords

  • Coagulation
  • Fibrinolysis
  • Measurement techniques
  • Thrombelastography
  • Tissue type plasminogen activator
  • ε-aminocaproic acid

ASJC Scopus subject areas

  • Hematology

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