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The association of epsilon-aminocaproic acid with postoperative decrease in creatinine clearance in 1502 coronary bypass patients.

Publication ,  Journal Article
Stafford-Smith, M; Phillips-Bute, B; Reddan, DN; Black, J; Newman, MF
Published in: Anesth Analg
November 2000

UNLABELLED: Renal dysfunction is a common serious complication after cardiac surgery. Reports of proteinuria and hyperkalemia after cardiac surgery with epsilon-aminocaproic acid (EACA) have therefore raised concerns for renal safety. Since EACA renders these markers unreliable, we used perioperative change in creatinine clearance (DCrCl) to test the hypothesis that EACA is associated with greater reductions in creatinine clearance after heart surgery, particularly for patients with renal disease. We evaluated data from all elective primary coronary bypass patients during EACA introduction at our institution (July 1, 1991-December 31, 1992; 10 g iv bolus pre-cardiopulmonary bypass, then 1 g/h for 5 h). DCrCl was calculated using preoperative (CrPre) and postoperative peak serum creatinine values, using the Cockroft-Gault equation. Patients with CrPre > or = 133 micromol/L were also separately analyzed. Evaluated patients (n = 1502, +/-EACA; 581/905, 16 exclusions) included 233 with CrPre > or = 133 micromol/L (+/-EACA; 98/135). Multivariate analyses confirmed several known risk factors, but no association between DCrCl and EACA in all patients (P: = 0.66), and the subgroup with CrPre > or = 133 micromol/L (P: = 0.42). IMPLICATIONS: In a large population of primary Coronary Artery Bypass Graft including a subset with preoperative renal dysfunction, there were no postoperative reductions in creatinine clearance attributable to epsilon-aminocaproic (EACA) administration. This retrospective study suggests that moderate epsilon-aminocaproic acid dosing during cardiac surgery is safe for the kidney; however, this inference is based on a single marker of renal dysfunction and requires prospective confirmation using a variety of tests of renal function.

Duke Scholars

Published In

Anesth Analg

DOI

ISSN

0003-2999

Publication Date

November 2000

Volume

91

Issue

5

Start / End Page

1085 / 1090

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Kidney
  • Humans
  • Female
  • Creatinine
  • Coronary Artery Bypass
  • Cardiopulmonary Bypass
 

Citation

APA
Chicago
ICMJE
MLA
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Stafford-Smith, M., Phillips-Bute, B., Reddan, D. N., Black, J., & Newman, M. F. (2000). The association of epsilon-aminocaproic acid with postoperative decrease in creatinine clearance in 1502 coronary bypass patients. Anesth Analg, 91(5), 1085–1090. https://doi.org/10.1097/00000539-200011000-00008
Stafford-Smith, M., B. Phillips-Bute, D. N. Reddan, J. Black, and M. F. Newman. “The association of epsilon-aminocaproic acid with postoperative decrease in creatinine clearance in 1502 coronary bypass patients.Anesth Analg 91, no. 5 (November 2000): 1085–90. https://doi.org/10.1097/00000539-200011000-00008.
Stafford-Smith M, Phillips-Bute B, Reddan DN, Black J, Newman MF. The association of epsilon-aminocaproic acid with postoperative decrease in creatinine clearance in 1502 coronary bypass patients. Anesth Analg. 2000 Nov;91(5):1085–90.
Stafford-Smith, M., et al. “The association of epsilon-aminocaproic acid with postoperative decrease in creatinine clearance in 1502 coronary bypass patients.Anesth Analg, vol. 91, no. 5, Nov. 2000, pp. 1085–90. Pubmed, doi:10.1097/00000539-200011000-00008.
Stafford-Smith M, Phillips-Bute B, Reddan DN, Black J, Newman MF. The association of epsilon-aminocaproic acid with postoperative decrease in creatinine clearance in 1502 coronary bypass patients. Anesth Analg. 2000 Nov;91(5):1085–1090.

Published In

Anesth Analg

DOI

ISSN

0003-2999

Publication Date

November 2000

Volume

91

Issue

5

Start / End Page

1085 / 1090

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Kidney
  • Humans
  • Female
  • Creatinine
  • Coronary Artery Bypass
  • Cardiopulmonary Bypass