Aminocaproic acid use in hospitalized patients with hematological malignancy: a case series

Abstract

The antifibrinolytic aminocaproic acid is widely used in surgical settings to prevent blood loss and decrease transfusion requirements, and small observational studies have suggested that aminocaproic acid may be useful in the setting of malignancy-related bleeding. At our institution, aminocaproic acid is sometimes prescribed to patients with hematological malignancy who experience refractory thrombocytopenia with or without bleeding. We performed a 5-year retrospective review of 54 adult patients with 13 types of hematological malignancy who received aminocaproic acid at our institution. Indications for use included 31 (57.4%) for refractory thrombocytopenia with bleeding, 16 (29.6%) for refractory thrombocytopenia without bleeding, and 7 (13%) for bleeding alone. Patients received both oral and intravenous formulations. Administered doses ranged broadly and median duration of use was 6 days. Three patients (5.7%) developed deep venous thrombosis but none of the thrombotic events were clearly related to administration of aminocaproic acid. We conclude that aminocaproic acid may be a relatively safe and cost-effective adjunct treatment in the setting of bleeding related to the diagnosis and treatment of hematological malignancy. Prospective trials as well as formalized protocols for the use of aminocaproic acid may be indicated. Copyright © 2015 John Wiley & Sons, Ltd.

Transfusion Challenges in Patients with Hematological Malignancies in Sub-Saharan Africa: A Prospective Observational Study from the Uganda Cancer Institute

“…Furthermore, physicians could consider alternatives to transfusion and implement strategies that include pharmacological correction of anemia using erythropoietin (although expensive), oral or intravenous iron (in selected patients), and use of antifibrinolytics (e.g. epsilon aminocaproic acid) to prevent bleeding in patients with thrombocytopenia [22][23][24] .…”

Treatment of Diffuse Alveolar Hemorrhage: Controlling Inflammation and Obtaining Rapid and Effective Hemostasis

“…However, TXA therapy failed to show significant effect on reducing bleeding-associated mortality in patients with hematologic malignancies [66] but also increased risk of post-operative seizures [67] and showed limited efficacy on profound and recurrent bleedings [65]. EACA, another option for hemostatic treatment, is a lysine analog that binds competitively to plasminogen, blocking plasminogen from binding to fibrin and the subsequent conversion to plasmin, resulting in the inhibition of fibrin degradation (fibrinolysis) [68]. EACA has been used in addition to corticosteroids in patients with post-transplant DAH and reported to reduce 100-day mortality rate from 83% to 44% in patients treated with corticosteroids [69].…”

Challenges and Advances in Managing Thrombocytopenic Cancer Patients

“…EACA was associated with a low risk of major spontaneous bleeding and was well tolerated [57]. Two additional retrospective studies (2016, 2018) provided additional safety data by demonstrating no increase in VTE rates with EACA as prophylactic therapy in thrombocytopenic patients with hematological malignancy [58,59]. The PROBLEMA Trial, a phase II control trial study evaluating the effectiveness and safety of EACA versus prophylactic platelet transfusions to prevent bleeding in thrombocytopenic patients with hematological malignancies, is still ongoing [60].…”