The effect of ε‐aminocaproic acid on blood product requirement, outcome and thromboelastography parameters in severely thrombocytopenic dogs

Abstract

BackgroundNo treatment other than platelet administration is known to protect against spontaneous hemorrhage in thrombocytopenic dogs.ObjectivesPrimary: determine if treatment with ε‐aminocaproic acid (EACA) decreases the requirement for blood transfusions and improves outcome in dogs with severe thrombocytopenia. Secondary: find evidence of hyperfibrinolysis and determine the effect EACA administration on rapid (rTEG) and tissue plasminogen activator‐spiked (tPA‐rTEG) thromboelastography parameters.AnimalsTwenty‐seven dogs with severe thrombocytopenia were treated with EACA, and data from an additional 33 were obtained from the hospital database as historical control (HC) cohort.MethodsSingle arm clinical trial with HCs. The EACA group dogs received EACA (100 mg/kg IV followed by a constant‐rate infusion [CRI] of 400 mg/kg/24 hours). Thromboelastography before and during EACA infusion, hospitalization days, number of transfusions, and mortality were compared.ResultsNo difference was found in number of transfusions per dog (median, interquartile range; 1, 0‐2.5 vs 0.9, 0‐2; P = .5) and hospitalization days (4, 4‐6 vs 4.5, 3.75‐6; P = .83) between HC and EACA groups, respectively, and no difference in survival was identified by log‐rank analysis (P = .15). Maximum amplitude on both rTEG and tPA‐rTEG increased after EACA administration (rTEG baseline: 23.6, 9.6‐38.9; post‐EACA: 27.3, 19.8‐43.2; P < .001; tPA‐rTEG baseline: 23, 10.9‐37.2; post‐EACA: 24.7, 16.7‐44.8; P < .002).Conclusions and Clinical ImportanceAlthough EACA increased clot strength, there was no effect on outcome. Treatment with EACA at this dosage cannot be recommended as a routine treatment but may be considered for dogs with severe ongoing hemorrhage.

ACVIM consensus statement on the treatment of immune thrombocytopenia in dogs and cats

“…Available evidence on the use of aminocaproic acid in dogs with ITP suggests antifibrinolytics may increase clot strength, but associations with transfusion requirements, duration of hospitalization, or survival have not been demonstrated. 177 Similarly, use of tranexamic acid did not alter outcomes in a small cohort study but was associated with an increased incidence of vomiting. 178 When determining the duration of hospitalization, clinicians should consider the nature, location and extent of bleeding, the stability of the patient's hematocrit and need for RBC transfusion, and the trend of the patient's platelet count.…”