Caproamin Fides® Versus Transamin® in High Risk Patients Undergoing CABG

This randomized clinical trial was carried out so as to discover the efficacy of both ɛ-aminocaproic acid (Caproamin Fides®) and tranexamic acid (Transamin®) among high risk patients in primary coronary artery bypass grafting surgery.

From December 2010 to January 2013, 100 consecutive high-risk adult patients undergoing CABG at Rajaie Cardiovascular Medical & Research Center, Tehran, Iran were included in this randomized double-blinded study. Patients who had a past history of, coagulation disorders and allergy reactions to both Caproamin Fides® and Transamin® were excluded. One group of patients received 150 mg/kg Caproamin Fides at the beginning of surgical incision and an additional 1 gr/h during operation (group 1). The second group were administered transamin with a primary dose of 10 mg/kg infusion being coincident with surgical incision (group 2). Then, patients were followed by their blood transfusion volumes, mediastinal bleeding and postoperative complications.

One hundred patients as 79 males and 21 females with ages at the mean of 66.4 ± 7 years were enrolled in the study. The mean volumes of chest drainage in group one (416 ± 322 in 24 hours and 681 ± 374 in 48 hours) and group 2 (420 ± 303 in 24 hours and 532 ± 399 in 48 hours). The 56% of patients in Caproamin Fides group and 58% of patients in transamin group received a mean of 1.46 ± 1.06 and 1.65 ± 1.04 units of packed cell respectively. During ICU stay 66% of patients in Caproamin Fides group and 25% of patients in transamin group required additional red blood cell transfusion at the rate of 2.4 ± 1.8 and 1.5 ± 0.6 units. Only 1 patient in transamin group received a pack cell transfusion. There were no significant differences in postoperative major adverse cardiovascular and cerebrovascular events (MACCE) between two groups.

Caproamin Fides and transamin are both safe and effective in postoperative bleeding reduction. They also reduce the need for blood transfusion in high risk patients undergoing CABGs and could be used as an acceptable alternative for aprotinin. Tranexamic acid seems to be more effective regarding the need for blood product transfusion in these patients.