Original Article

Clinical and Hematological Outcomes of Aminocaproic Acid Use During Pediatric Cardiac ECMO

^* Children’s Healthcare of Atlanta, Atlanta, Georgia; and ^‡ Sibley Heart Center Cardiology, Children’s Healthcare of Atlanta, Atlanta, Georgia
^† Medical College of Georgia, Augusta, Georgia

Address correspondence to: Shriprasad R. Deshpande, MBBS, MS, Heart Transplant and Advanced CardiacTherapies Program, Department of Pediatric Cardiolgy, Children’s National Hospital, 111, Michigan Avenue NW, Washington, DC 20010. E-mail: sdeshpan@childrensnational.org

Received: 29 May 2020
Accepted: 6 January 2021

Abstract

Bleeding and thrombosis-related complications are common in pediatric cardiac patients supported by extracorporeal membrane oxygenation (ECMO) and are associated with morbidity and mortality. The purpose of this study was to evaluate the utility of aminocaproic acid (ACA), an antifibrinolytic agent, as it pertains to bleeding in pediatric cardiac patients on ECMO. This included a retrospective cohort study of pediatric cardiac patients receiving ACA while supported on ECMO between 2013 and 2017. For each patient, data were collected in three time intervals: the 24 hours before ACA initiation, and then 0–24 and 24–48 hours following ACA initiation. For each time frame, bleeding, component transfusion, and laboratory data were collected and analyzed. A total of 62 patients were included, representing 42% of our cardiac ECMO patients during the time period. ACA was initiated at 16.3 ± 8.7 hours following initiation of ECMO. The mean bleeding rate before ACA was 10.57 mL/kg/h, which reduced to 7.8 mL/kg/h in the 24-hour period after initiation of ACA and a further decrease to 3.65 mL/kg/h during the 24- to 48-hour time period following ACA initiation. ACA administration was associated with reduction in bleeding (p < .001) and packed red blood cell transfusions (p = .02), administration of fresh frozen plasma (p < .001), platelets (p = .017), cryoprecipitate (p = .05), factor VII (p = .002), and Cell Saver (p = .005). Hemoglobin and platelet count were stable, whereas prothrombin time (PT), partial thromboplastin time, and international normalized ratio (INR) showed significant reduction over the time course. ACA administration was not associated with specific adverse effects. A clinically significant reduction in bleeding amount, red blood cell transfusions, and other hematologic interventions occurred following ACA administration for pediatric patients on ECMO. Wider consideration for ACA use as a part of a multipronged strategy to manage bleeding during ECMO should be considered.