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At least 181 records · Page 10Linked to original sources
PubMed1997

Rhabdomyolysis induced by epsilon-aminocaproic acid.

OBJECTIVE: To report a case of rhabdomyolysis associated with epsilon-aminocaproic acid (epsilon-ACA). CASE SUMMARY: A 33-year-old female patient with chronic granulocytic leukemia was treated with epsilon-ACA for approximately 3.5 months for thrombocytopenic bleeding. The initial dosage was 4 g po q6h. One month after an increase in dosage to 5 g po 14h the patient developed severe lower extremity myalgia and marked weakness. Laboratory investigations revealed an elevated creatine kinase (CK), lactate dehydrogenase (LDH). aspartate aminotransferase (AST), and myoglobinemia. Epsilon-ACA was thought to be the causative agent and was discontinued. The patient received intravenous fluids to minimize renal damage due to myoglobin. Serum enzyme concentrations did not return to normal. The patient died of a central nervous system hemorrhage 1 week after the epsilon-ACA was discontinued. DISCUSSION: There were 31 cases of epsilon-ACA-induced myopathies published in the literature (MEDLINE) from 1972 to June 1995. Of these, 10 cases were reviewed. In all cases, patients received epsilon-ACA in doses ranging from 16 to 36 g/d for more than 28 days. Clinical findings varied from extreme muscle weakness to myopathic changes in electromyelograms. All patients recovered following discontinuation of epsilon-ACA. CONCLUSIONS: Long-term therapy with high-dose epsilon-ACA may produce muscle weakness or rhabdomyolysis. Patients who require long-term, high-dose epsilon-ACA therapy should be monitored for myoglobinuria and changes in serum CK, LDH, and AST, for myoglobinemia, for decreases in muscle strength, and/or for myalgia. Significant changes in these parameters compared with baseline values should suggest a need to discontinue epsilon-ACA therapy.

Adult↗
PubMed2002

Epsilon-aminocaproic acid and renal complications: case report and review of the literature.

Epsilon-aminocaproic acid (EACA) is a potent anti-fibrinolytic agent that is used in the treatment of excessive bleeding resulting from a systemic fibrinolytic state. It can also be used to treat hematuria through its action on decreasing urinary fibrinolysis. A broad range of renal complications has been ascribed to EACA. Although they are rare, they may be life-threatening and should therefore be immediately recognized.

Acute Kidney Injury↗
PubMed2005

Laboratory measures of hemostasis and fibrinolysis after intravenous administration of epsilon-aminocaproic acid in clinically normal horses and ponies.

OBJECTIVE: To determine whether epsilon-aminocaproic acid (EACA) administered IV affects hemostasis and fibrinolysis in clinically normal horses and ponies. ANIMALS: 20 clinically normal adult horses and ponies. PROCEDURES: Blood samples were collected 24 hours before (baseline) and 1 and 5 hours after i.v. administration of a low dose (30 mg/kg) or high dose (100 mg/kg) of EACA. Platelet count, fibrinogen concentration, prothrombin time, partial thromboplastin time (PTT), D-dimer concentration, alpha2-antiplasmin activity, and thrombin-antithrombin complex concentration were measured. Values at 1 and 5 hours were compared with baseline values. RESULTS: hour after administration of a low dose of EACA, mean fibrinogen concentration was significantly lower than baseline concentration. Mean PTT was significantly shorter than the baseline value 5 hours after administration of a low dose of EACA. One hour after administration of 100 mg of EACA/kg, mean alpha2-antiplasmin activity was significantly higher than baseline activity. Mean fibrinogen concentration was significantly lower than baseline concentration 1 and 5 hours after administration of a high dose of EACA. Mean PTT was significantly shorter than the baseline value 5 hours after administration of a high dose of EACA. CONCLUSIONS AND CLINICAL RELEVANCE: i.v. administration of 30 and 100mg of EACA/kg to clinically normal horses significantly modified some laboratory measures of hemostasis, consistent with its known antifibrinolytic effects. Although enhanced clot maintenance and diminished bleeding were not directly assessed, the clinical use of EACA may benefit some patients.

Aminocaproic Acid↗
PubMed2003

Epsilon-aminocaproic acid in coronary artery bypass graft surgery: preincision or postheparin?

BACKGROUND: Epsilon-aminocaproic acid (epsilon-ACA), an antifibrinolytic agent, is used in cardiac surgery to decrease postoperative bleeding. Theoretical concerns exist about the potential for epsilon-ACA to contribute to thrombotic complications. For this reason epsilon-ACA administration is sometimes delayed until after heparinization. This study investigated the impact of the timing of epsilon-ACA administration on its efficacy. METHODS: In this double-blind study, 90 patients undergoing primary coronary artery bypass graft surgery were prospectively randomized to receive either epsilon-ACA commencing prior to skin incision (bolus 150 mg/kg, followed by an infusion at 15 mg x kg(-1) x hr(-1), epsilon-ACA commencing after heparin (same doses), or placebo. All infusions were terminated at the end of cardiopulmonary bypass. Criteria for the transfusion of blood products were standardized. Postoperative chest tube drainage (at 6 h, 12 h, and at chest tube removal) and blood transfusion requirements of the three groups were compared. RESULTS: At all time intervals, the placebo group had significantly greater chest tube drainage than either of the two epsilon-ACA groups (P < 0.005). At no time did a significant difference exist between the two epsilon-ACA groups. A trend existed for the placebo group to require more blood products than either epsilon-ACA group. CONCLUSIONS: Epsilon-ACA produces a reduction in chest tube drainage in patients undergoing primary coronary artery bypass graft surgery. This effect is similar whether the drug is given prior to incision or following anticoagulation. Given the similar hemostatic efficacy and the theoretical potential for thrombotic complications, it may be prudent to administer epsilon-ACA following anticoagulation.

Aged↗
PubMed1992

Disseminated intravascular coagulation and excessive fibrinolysis in a patient with metastatic prostate cancer. Response to epsilon-aminocaproic acid.

BACKGROUND: Disseminated intravascular coagulation (DIC) and primary fibrinolysis have both been reported in association with prostate carcinoma. The correct diagnosis of the coagulopathy can be difficult and the appropriate management controversial. METHODS: A case is presented of a man in whom DIC and soft tissue hemorrhage developed after prostatic biopsy. The results of therapy and a review of the literature are discussed. RESULTS: Fibrinogen levels continued to decrease despite high-dose estrogen therapy, but they rapidly returned to normal after therapy with epsilon-aminocaproic acid. Although routine coagulation tests were suggestive of primary fibrinolysis, the results of the D-dimer assay confirmed that the patient had DIC associated with excessive fibrinolysis. CONCLUSION: A review of the literature suggests that most cases of primary fibrinolysis are probably DIC with excessive secondary fibrinolysis. In cases in which bleeding is the primary manifestation of DIC and there is a significant reduction in alpha-2-plasmin inhibitor activity, a trial of epsilon-aminocaproic acid and low-dose heparin should be considered. The failure in this case of estrogen therapy to correct the coagulopathy, despite a later good tumor response, is consistent with the delay in which anorchid testosterone levels are obtained after initiating treatment.

Adenocarcinoma↗
PubMed1979

Fluorescamine use in high-performance liquid chromatographic determination of aminocaproic acid in serum.

A sensitive and specific high-performance liquid chromatographic determination of aminocaproic acid in serum is described. omega-Aminocaprylic acid is used as an internal standard. To 10 microliter of serum, 10 microliter of the internal standard solution and 50 microliter of ethanol are added. After centrifugation, a portion of the supernate is evaporated. The residue is dissolved in 750 microliter of 50 mM dibasic sodium phosphate, and then 250 microliter of fluorescamine in acetonitrile (35 mg/100 ml) is added. The reaction mixture is chromatographed using a column of octadecylsilane bonded to silica and 44% acetonitrile in 0.5 mM phosphoric acid as the eluent. Quantitation is achieved by monitoring either the absorbance of the effluent at 405 nm or the fluorescence of the compounds with a fluorometer equipped with a flowcell. The method is reproducible, simple, and fast and has a precision of 4.4%.

Aminocaproates↗
PubMed2000

Synthesis and conformation of Gly-Gly dipeptides constrained with phenylalanine-like aminocaproic acid linkers.

[structure: see text] The constraint of dipeptides with linkers derived from 6-aminocaproic acid (Aca) is a useful means of constructing a beta-turn peptidomimetic. The extension of this concept to the mimicry of a tripeptide entails the incorporation of a side chain moiety on either end of the Aca chain. The synthesis and conformational analysis of two exemplary compounds is discussed.

Aminocaproic Acid↗
PubMed2006

Successful use of recombinant activated FVII and aminocaproic acid in four neonates with life-threatening hemorrhage.

Reports on the use of recombinant activated factor VII (rFVIIa) to counteract hemorrhagic shock in neonates and preterm infants are increasing. rFVIIa enhances thrombin generation in situations with impaired thrombin formation and, since thrombin has a crucial role in providing hemostasis, rFVIIa is regarded as a general hemostasis agent. Full thrombin generation is necessary for the formation of a stable fibrin plug resistant to premature fibrinolysis. Antifibrinolytic drugs are not recommended for the treatment of acute bleeding. We report four neonates (one with massive postsurgical hemorrhage after ileostomy and three with severe pulmonary hemorrhage in the course of mechanical ventilation for meconium aspiration syndrome, congenital heart disease and during postoperative resuscitation after cardiac surgery for congenital heart disease) who were successfully treated with multiple administration of rFVIIa (120 microg/kg per dose) and antifibrinolytic therapy - aminocaproic acid (100 mg/kg per dose). In a fibrinolytic environment therapeutic concentrations of rFVIIa may sometimes be insufficient to produce adequate amounts of thrombin necessary for stable clot structure. Laboratory data in three of our patients with pulmonary hemorrhage (low fibrinogen levels with slightly prolonged prothrombin time) supported this thesis, so we blocked fibrinolysis with aminocaproic acid and achieved a complete clinical and laboratory therapeutic effect.

Aminocaproic Acid↗
PubMed1980

Epsilon-aminocaproic acid and recurrent subarachnoid hemorrhage: a clinical trial.

A clinical trial of epsilon-aminocaproic acid (EACA) in preventing recurrent hemorrhage from intracranial arterial aneurysms is reported. Previous reports were reviewed, and their results concerning antifibrinolytic agents were inconclusive in establishing their efficacy. One hundred patients with documented ruptured intracranial aneurysms were admitted to this study within 48 hours of the initial hemorrhage: 45 patients received 36 gm of EACA/day, with 11 documented rebleeds and one suspected rebleed. No benefit was seen from the use of EACA.

Aminocaproates↗
PubMed1975

Reactions of pyrzdoxal 5'-phosphate, 6-aminocaproic acid, cysteine, and penicilamine. Models for reactions of Schiff base linkages in pyridoxal 5'-phosphate-requiring enymes.

Schiff base formation, transaldimination, and reaction with aminothiols are important reactions which occur on the surface of pyridoxal-P-requiring enzymes. As a first step in assessing the role of the protein in these reactions, models for these reactions were studied in the absence of enzyme at 25 degrees, gamma/2 0.28. The reaction of 6-aminocaproic acid with pyridoxal-P to form the Schiff base N6-(P-pyridoxylidene)-aminocaproic acid was studied as a model for formation of Schiff base on the holoenzyme...

Aminocaproates↗
PubMed1981

Pharmacokinetics of epsilon-aminocaproic acid during peritoneal dialysis.

Two patients requiring peritoneal dialysis were treated with epsilon-aminocaproic acid (EACA), an antifibrinolytic agent. Samples of serum and dialysate were assayed for EACA concentrations. Total body clearance, dialysis clearance, EACA half-life, and volume of distribution of EACA were calculated. Total body clearance of EACA was 26 ml/min, which is 25% of the drug clearance in patients with normal renal function. Our results suggest that patients undergoing peritoneal dialysis should receive 25% of the usual recommended dose of EACA. Dialysis clearance accounted for only 58% of total body clearance, suggesting an alternative route of elimination of EACA.

Aminocaproates↗
PubMed1980

Effect of probenecid on the kinetics of epsilon-aminocaproic acid.

Healthy male subjects received, 1 wk apart, single oral doses of epsilon-aminocaproic acid (EACA) 100 mg/kg alone, EACA within probenecid (0.5 gm), or EACA 2 hr after 2.0 gm probenecid. Probenecid (2.0 gm) reduced the 8-hr urinary clearance and recovery of EACA by 50% without affecting plasma kinetics. Recovery of EACA in urine rose to 78% of the dose 48 hr after EACA. Plasma clearance of EACA did not differ from control EACA urinary clearance when 0.5 gm probenecid was given with EACA. In both cases all the EACA dose was recovered in urine within 8 hr.

Aminocaproates↗
PubMed1991

Aminocaproic acid versus prednisone for the treatment of traumatic hyphema. A randomized clinical trial.

One hundred twelve patients who sustained hyphema after blunt trauma were enrolled in a double-blind randomized clinical trial to determine the relative efficacies of aminocaproic acid (Amicar) and systemic prednisone for reducing the rate of secondary hemorrhage. Fifty-six patients received an oral dosage of 50 mg/kg of aminocaproic acid every 4 hours for 5 days, up to a maximum of 30 g daily, and 56 patients received an oral dosage of 40 mg of prednisone daily (adjusted for weight) in two divided doses. Placebo pills and liquids were given to each patient to mask the treatment schedules. There were no statistically significant differences between the patient populations for any demographic or clinical characteristic (e.g., visual acuity, intraocular pressure [IOP], initial hyphema size) measured in the study. Blacks comprised 53% of the study population, and the mean age of the patients was 23.5 years. Four patients in each of the treatment groups experienced a secondary hemorrhage; the rebleed rate was 7.1% in each group.

Administration, Oral↗
PubMed1984

Kinetics of epsilon-aminocaproic acid distribution, elimination, and antifibrinolytic effects in normal subjects.

The kinetics of epsilon-aminocaproic acid (EACA) distribution and elimination were studied in six normal subjects after a single 10-gm iv dose. Steady-state distribution volume averaged 30.01 or 0.39 l/kg. Mean elimination t 1/2 was 294 min and the elimination clearance was 0.19 l/min. Renal excretion of unchanged EACA accounted for 68% of its elimination and renal EACA clearance averaged 115% of creatinine clearance. EACA antifibrinolytic effect kinetics were also characterized in five of the subjects by the monitoring of clot lysis times in whole blood and platelet-rich plasma. Peak antifibrinolytic effects were observed 15 to 60 min after peak EACA plasma concentrations were attained. A model of maximal fibrinolysis inhibition (Emax) was used to estimate a half-maximal inhibition (IC50) of 63 +/- 19.7 microgram/ml. This agrees with the value of 0.55 mM or 72 microgram/ml that has been reported for the dissociation constant of the EACA-plasminogen complex and is consistent with the proposed biochemical mechanism of EACA action.

Adult↗
PubMed1991

Therapy of the Kasabach-Merritt syndrome with cryoprecipitate plus intra-arterial thrombin and aminocaproic acid.

A patient with the Kasabach-Merritt syndrome with disseminated intravascular coagulopathy and congestive heart failure due to a giant hepatic cavernous hemangioma achieved thrombosis of his tumor with a combination of cryoprecipitate plus intra-arterial thrombin and epsilon aminocaproic acid. This was documented by an absence of Indium 111-labelled platelet sequestration, marked decrease in thrombin:antithrombin complex generation, and normalization of platelet count and fibrinogen. Interventional angiography with aminocaproic acid and thrombin is advocated in patients whose tumors are amenable to such an approach so as to avoid a systemic antifibrinolytic state.

Aged↗
PubMedDate not supplied

The preventative effect of the antifibrinolytic agents, epsilon-aminocaproic acid and tranexamic acid, on stress ulcer formation in rats.

The effect of the antifibrinolytic agents, epsilon-aminocaproic acid (EACA) and tranexamic acid (t-AMCHA), on acute gastric ulcers induced by cold restraint stress in rats was studied. Intravenous administration of 500 mg/Kg of EACA and t-AMCHA before exposure to stress significantly reduced the severity of gastric bleeding and ulcer formation (P less than 0.01). These agents did not affect gastric acid secretion in pylorus-ligated rats. The results indicate that antifibrinolytic agents may be beneficial in the prevention of stress ulcers in man and support the concept that local gastric fibrinolysis may play a role in the pathogenesis of stress ulcers.

Aminocaproates↗