Thromboembolic complications following aminocaproic acid use in patients with hematologic malignancies

Juhl, Rebecca C; Roddy, Julianna; Wang, Tzu‐Fei; Elefritz, Jessica

doi:10.1080/10428194.2018.1434882

Cited by 13 publications

(11 citation statements)

References 10 publications

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“…However, evidence supporting the use of antifibrinolytic agents in acute leukemia patients remains limited and is largely based on single‐center retrospective studies and pre‐1990 small randomized trials (Table 2). 3,61‐70 Most studies were small, single‐arm studies without a control group, employing various dosing strategies, and with highly variable outcome reporting (Table 2). The GIMEMA and PETHEMA studies both did not demonstrate a therapeutic benefit of antifibrinolytic agents to reduce hemorrhagic mortality in patients with APL 3,71 .…”

Section: Platelet Transfusionmentioning

confidence: 99%

Management of hemostatic complications in acute leukemia: Guidance from the SSC of the ISTH

Wang

Makar

Levy

et al. 2020

Journal of Thrombosis and Haemostasis

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Patients with acute leukemia frequently develop thrombocytopenia and hemostatic complications caused by coagulopathy. Coagulopathy complicates the management of these patients and can lead to significant morbidity and mortality. This guidance document aims to review and provide guidance on the management of hemostatic complications in adult patients with acute leukemia, addressing four main issues, including platelet transfusion, disseminated intravascular coagulation, L‐asparaginase‐related hypofibrinogenemia, and the use of antifibrinolytic agents.

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Section: Platelet Transfusionmentioning

confidence: 99%

Management of hemostatic complications in acute leukemia: Guidance from the SSC of the ISTH

Wang

Makar

Levy

et al. 2020

Journal of Thrombosis and Haemostasis

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“…, Juhl et al . ), but this has not been established in cats and dogs. Empirical use of these drugs is therefore not recommended in patients with prothrombotic conditions.…”

Section: Treatment Of Hyperfibrinolytic Disordersmentioning

confidence: 95%

“…In people, the incidence of thromboembolism associated with the administration of antifibrinolytic agents is reported to be low (Ker et al 2015, Nicolau-Raducu et al 2016, Juhl et al 2018, but this has not been established in cats and dogs. Empirical use of these drugs is therefore not recommended in patients with prothrombotic conditions.…”

Section: Treatment Of Hyperfibrinolytic Disordersmentioning

confidence: 99%

A review of hyperfibrinolysis in cats and dogs

Birkbeck

Humm

Cortellini

2019

J of Small Animal Practice

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The fibrinolytic system is activated concurrently with coagulation; it regulates haemostasis and prevents thrombosis by restricting clot formation to the area of vascular injury and dismantling the clot as healing occurs. Dysregulation of the fibrinolytic system, which results in hyperfibrinolysis, may manifest as clinically important haemorrhage. Hyperfibrinolysis occurs in cats and dogs secondary to a variety of congenital and acquired disorders. Acquired disorders associated with hyperfibrinolysis, such as trauma, cavitary effusions, liver disease and Angiostrongylus vasorum infection, are commonly encountered in primary care practice. In addition, delayed haemorrhage reported in greyhounds following trauma and routine surgical procedures has been attributed to a hyperfibrinolytic disorder, although this has yet to be characterised. The diagnosis of hyperfibrinolysis is challenging and, until recently, has relied on techniques that are not readily available outside referral hospitals. With the recent development of point‐of‐care viscoelastic techniques, assessment of fibrinolysis is now possible in referral practice. This will provide the opportunity to target haemorrhage due to hyperfibrinolysis with antifibrinolytic drugs and thereby reduce associated morbidity and mortality. The fibrinolytic system and the conditions associated with increased fibrinolytic activity in cats and dogs are the focus of this review article. In addition, laboratory and point‐of‐care techniques for assessing hyperfibrinolysis and antifibrinolytic treatment for patients with haemorrhage are reviewed.

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“…Patients were assessed for thrombosis if they were alive and in the hospital 14 days post-aminocaproic acid based on previously published data. 18,19 Fourteen days were chosen to capture the potential association with administration of aminocaproic acid as 7 days may be too short and thrombosis events greater than 14 days are more likely to be related to other causes. Deep vein thrombosis was confirmed by venous duplex ultrasonography, symptomatic pulmonary embolism by a combination of elevated troponins, electrocardiography changes, ventilation-perfusion lung scan, computed tomography (CT) angiogram of the chest, and ischemic stroke by a CT or magnetic resonance imaging of the head.…”

Section: Methodsmentioning

confidence: 99%

Aminocaproic Acid for the Reversal of Alteplase: A Case Series

Verkerk

Berger

Lesch

2019

Journal of Pharmacy Practice

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Introduction: The evidence to support the use of aminocaproic acid for reversal of alteplase is limited to case reports. Current guidelines recommend cryoprecipitate as first-line treatment, or an antifibrinolytic if cryoprecipitate is unavailable or cannot be used. This case series describes the use of aminocaproic acid for alteplase-related hemorrhage. Materials and Methods: Patients who received aminocaproic acid within 48 hours of alteplase from January 1, 2014, to June 30, 2017 were included. Patients were excluded if aminocaproic acid was not administered for an alteplase-related hemorrhage. Thromboembolic complications at 14 days and hemostasis within 24 hours were documented. Results: Sixteen patients received aminocaproic acid for an alteplase-related hemorrhage. Aminocaproic acid was given for hemorrhagic conversion of acute ischemic stroke in 7 of 16 patients and other types of hemorrhages in the remaining patients. Hemostasis occurred in 3 of 10 evaluable patients. Overall mortality was 63% (10/16). Administration of aminocaproic acid varied significantly (50% bolus, 12.5% infusion, 37.5% bolus plus infusion). One of 6 evaluable patients had a thromboembolic event. All patients received concomitant blood products. Cryoprecipitate was administered in 69% (11/16) of patients. Conclusions: There was no clear relationship between the timing or dose of aminocaproic acid and hemostasis, and it is unclear if administration of aminocaproic acid contributes to hemostasis.

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Thromboembolic complications following aminocaproic acid use in patients with hematologic malignancies

Cited by 13 publications

References 10 publications

Management of hemostatic complications in acute leukemia: Guidance from the SSC of the ISTH

Management of hemostatic complications in acute leukemia: Guidance from the SSC of the ISTH

A review of hyperfibrinolysis in cats and dogs

Aminocaproic Acid for the Reversal of Alteplase: A Case Series

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