Fibrinolysis in Haemophilia: The Effect of ε‐Amino‐Caproic Acid

Abstract

In 1962 Abe, Sato, Kazama and Matsumura reported that two boys suffering from haemophilia had improved during treatment with ε‐amino‐caproic acid (ε‐A.C.A.) as shown by a diminished number of haemorrhages and decreased need for blood transfusions and that this improvement was associated with reduced fibrinolytic activity. In order to assess the effect of ε‐A.C.A. in haemophilia, a trial has been conducted in six boys over a period of 6 months. They were all suffering from haemophilia A and their previous histories were available. During the trial they were seen at fortnightly intervals and on each visit a full record of all haemorrhagic episodes since the last visit was made, together with any subjective comments from the patient or his parents about pain, mobility, etc. At each visit a specimen of venous blood was taken for estimation of fibrinolytic activity, the patients attending at the same time of day in order to minimize physiological diurnal variation (Fearnley, 1960). Any changes in diet, activity or habits during the preceding 24 hours were also noted. Fibrinolytic activity was measured by the method of Lackner and Goosen (1959) (which is a modification of that originally described by Fearnley, Balmforth and Fearnley, 1957). During the first 3 months half of the patients were on treatment with ε‐A.C.A. and during the second 3 months the other half. The dosage was calculated by the percentage method (Catzel, 1962) based on the daily adult dose of 10 g. per day. No treatment was given during the control period.

Abrogating fibrinolysis does not improve bleeding or rFVIIa/rFVIII treatment in a non‐mucosal venous injury model in haemophilic rodents

“…Although antifibrinolytic drugs have been proven to be effective as adjunctive HA therapy for mucosal bleeds , in non‐mucosal tissues they are mainly used empirically. Only limited evidence supports the use of antifibrinolytic drugs in cases of non‐mucosal bleeding and in surgical operations . Moreover, no study has definitively shown the usefulness of systemic TXA therapy in patients with HA.…”

Antifibrinolytic Treatment in Haemophilia: A Controlled Trial of Prophylaxis with Tranexamic Acid

“…Initial suggestions (Abe et ul, 1962;Reid et af, 1965) were based on uncontrolled subjective evaluations. Mainwaring & Keidan (1965) reported subjective improvement in five out of six children treated for 3 mth when compared with a similar period of no treatment. Reid et a1 (1967) compared the experience of two groups of patients treated for varying lengths of time following an initial period of observation.…”

“…Previous reports have suggested that inhibition of fibrinolysis with epsilon-aminocaproic acid (EACA) is of prophylactic value in the treatment of haemophilia (Abe et al, 1962;Reid etal, 1965Reid etal, , 1967Mainwaring & Keidan, 1965;Gordon et a!, 1965). However, Strauss et al (1965) failed to demonstrate a reduction in the number of bleeding events or in the amount of replacement therapy required, and did not register fewer hospital admissions as a result of treatment, and they concluded that EACA was of no benefit.…”

Recent Trends in Antifibrinolytic Therapy

“…Though good results have been achieved in patients with haemophilia A and B treated either prophylactically (Abe et al 1962; Mainwaring and Keidan 1965) or after dental extraction with EACA (Reid et al 1964) more experience is necessary (Pechet 1965). Other authors (McNicol et al 1961; Steiger et al 1962) have also reported encouraging results with EACA when treating haematuria in haemophilic patients.…”