From the Guidelines
The recommended dose of Amicar for cardiopulmonary bypass (CPB) is a loading dose of 75 to 150 mg/kg, with additional dosing from 12.5 to 30 mg/kg/h infused over varying time periods. When considering the use of Amicar in CPB, it is essential to understand its role as an antifibrinolytic agent, which helps prevent fibrin degradation and preserve clot stability during the highly thrombogenic environment of CPB 1. The dosing regimen for Amicar can vary, but the most commonly reported range is a loading or bolus dose of 75 to 150 mg/kg, followed by an infusion of 12.5 to 30 mg/kg/h 1. Key considerations for the use of Amicar in CPB include:
- The need for renal dose adjustment in patients with kidney impairment, as Amicar is primarily excreted by the kidneys
- The potential for hypotension during rapid administration, which can be mitigated by giving the loading dose over at least 30 minutes
- The importance of monitoring for signs of bleeding or thrombosis, as Amicar can affect both fibrinolysis and coagulation. Overall, the use of Amicar in CPB can help reduce perioperative blood loss and transfusion requirements, but its dosing and administration must be carefully managed to minimize potential side effects 1.
From the Research
Dose of Amicar for CPB
The dose of Amicar (epsilon-aminocaproic acid) for cardiopulmonary bypass (CPB) is not explicitly stated in the provided studies as a single, universally accepted value. However, various studies provide insight into the dosing regimens used:
- A study from 1993 2 mentions the use of 10 g and 15 g of EACA, administered as intravenous infusions over 2 hours, from the time of anesthetic induction until the onset of CPB.
- A comparison study from 2004 3 used aminocaproic acid 100 mg/kg at anesthetic induction, on bypass, and after protamine reversal of heparin.
- Another study from 2022 4 compares fixed-dose TXA versus EACA, with EACA administered as 7.5 g intravenous boluses followed by a 1-1.25 g/h infusion for the duration of the surgery.
Key Points
- The dosing of Amicar can vary based on the specific protocol of the institution or the preferences of the surgical team.
- Studies suggest that both high and lower doses of EACA can be effective in reducing postoperative bleeding in cardiac surgery patients undergoing CPB.
- The choice between different antifibrinolytic agents (such as tranexamic acid and epsilon-aminocaproic acid) may depend on various factors including drug availability, patient-specific risk factors, and institutional protocols 5, 6, 4.
- It is crucial to consider the balance between the efficacy of these agents in reducing bleeding and the potential for adverse effects, such as thromboembolic complications, although these have been rare in the studies reviewed 5.