Efficacy of Epsilon Aminocaproic Acid Versus Placebo in Coronary Artery Bypass Graft: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The aim of this study was to investigate the efficacy of epsilon aminocaproic acid (EACA) as a prophylactic antifibrinolytic agent in patients undergoing coronary artery bypass graft (CABG) surgery.

A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the efficacy of EACA in CABG surgery with placebo groups was performed. The outcomes assessed included postoperative 24-h and total blood loss, pre- and postoperative hemoglobin change, and blood transfusion requirements.

A total of 16 RCTs with 897 participants were included in the meta-analysis. The analysis revealed that EACA significantly reduced 24-h postoperative blood loss compared to placebo (WMD = -135 ml, 95% CI: -217, -53 ml, I² = 65.3%). However, there was no significant difference in total blood loss between the EACA and placebo groups. EACA administration also reduced the transfusion rate for platelets (WMD = -0.09, 95% CI: -0.1, –0.02, I² = 65.3%), but not for red blood cells, fresh frozen plasma, or cryoprecipitate. There was no significant difference in hemoglobin decline between EACA and placebo groups.

This meta-analysis suggests the use of EACA as a prophylactic antifibrinolytic agent in CABG surgery. It effectively reduces postoperative 24-h 24-h blood loss compared with placebo after coronary artery bypass graft (CABG) and potentially minimizing the need for platelet transfusions. There were no significant differences between EACA and placebo in terms of total blood loss, hemoglobin decline, and the need for red blood cells, fresh frozen plasma, or cryoprecipitate. Further research is needed to evaluate optimal dosage regimens and long-term outcomes of EACA administration.