What is the correct spelling and usage of epsilon aminocaproic acid (EACA)?

Correct Spelling and Usage of Epsilon Aminocaproic Acid (EACA)

The correct spelling is "epsilon aminocaproic acid" (EACA), which is a synthetic lysine analogue that acts as an antifibrinolytic agent by inhibiting the plasmin-plasminogen system. 1

Chemical Properties and Formulation

• EACA is chemically known as 6-aminohexanoic acid with the molecular formula C₆H₁₃NO₂ and a molecular weight of 131.17 2
• It is soluble in water, acid, and alkaline solutions; sparingly soluble in methanol; and practically insoluble in chloroform 2
• The injectable formulation contains 250 mg/mL of EACA with benzyl alcohol 0.9% as a preservative 2

Mechanism of Action

• EACA inhibits both plasminogen activators and, to a lesser degree, plasmin activity 2
• It competitively binds to plasmin and plasminogen by bearing structural similarity to lysine, preventing the breakdown of fibrin or fibrinogen 3
• This mechanism "switches off" fibrinolysis, resulting in less bleeding during procedures 3

Dosing Guidelines

• For adults, the standard loading dose is 150 mg/kg followed by a continuous infusion of 15 mg/kg/h 3
• The initial elimination half-life is 60-75 minutes, necessitating continuous infusion to maintain therapeutic drug levels 3
• In pediatric cardiac surgery, dosing regimens have included:
  • Loading dose of 100 mg/kg followed by continuous infusion of 30 mg/kg/h for 72 hours 3
  • Loading doses of 75-150 mg/kg with maintenance infusions of 15-30 mg/kg/h 3

Clinical Applications

• Used in cardiac surgery to reduce blood loss and need for transfusions 3
• Employed in trauma patients with significant hemorrhage 3
• Utilized for long-term prophylaxis in hereditary angioedema, though generally less effective than androgens 3
• Applied in thrombocytopenic hemorrhage to reduce transfusion requirements 4
• Used as adjunctive therapy in hemophilia patients with inhibitors 5

Precautions and Contraindications

• Should NOT be administered without a definite diagnosis and/or laboratory finding indicative of hyperfibrinolysis 2
• Rapid intravenous administration should be avoided as it may induce hypotension, bradycardia, and/or arrhythmia 2
• Use with caution in patients with renal dysfunction as EACA is primarily eliminated through renal clearance 6
• Should not be administered with Factor IX Complex concentrates or Anti-Inhibitor Coagulant concentrates due to increased thrombosis risk 2
• Benzyl alcohol in the injectable formulation has been associated with a fatal "gasping syndrome" in neonates 2

Potential Side Effects

• Major side effects include hypotension, cardiac arrhythmias, rhabdomyolysis, and potential thrombi formation 1
• Renal complications, though rare, can be life-threatening and should be immediately recognized 7
• Prolongation of template bleeding time has been reported during continuous IV infusion at dosages exceeding 24 g/day 2
• Common side effects with antifibrinolytics include nausea, vertigo, diarrhea, postural hypotension, fatigue, and muscle cramps 3

Clinical Evidence in Special Populations

• In liver transplantation, EACA effectively treats fibrinolysis without increasing risk of hepatic artery and vein thrombosis 8
• In neonates receiving ECMO, EACA appears safe but may not significantly decrease overall hemorrhagic complications 3
• In pediatric cardiac surgery, EACA has demonstrated decreased bleeding, transfusion requirements, and laboratory evidence of fibrinolysis 3

The correct spelling and appropriate clinical usage of epsilon aminocaproic acid are important for ensuring proper documentation, ordering, and administration of this medication in various clinical settings.